Provider Demographics
NPI:1659410306
Name:WILKINSON, KINNITH DALE JR (PT)
Entity Type:Individual
Prefix:MR
First Name:KINNITH
Middle Name:DALE
Last Name:WILKINSON
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7779
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93290-7779
Mailing Address - Country:US
Mailing Address - Phone:559-733-2478
Mailing Address - Fax:559-733-2470
Practice Address - Street 1:5533 W HILLSDALE AVE STE A
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5367
Practice Address - Country:US
Practice Address - Phone:559-733-2478
Practice Address - Fax:559-733-2470
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT15525225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT155250Medicare ID - Type Unspecified