Provider Demographics
NPI:1740604842
Name:WILKINSON, AYLEICA (BS)
Entity Type:Individual
Prefix:
First Name:AYLEICA
Middle Name:
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7315 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-6821
Mailing Address - Country:US
Mailing Address - Phone:402-393-6911
Mailing Address - Fax:402-393-7838
Practice Address - Street 1:7315 MAPLE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-6821
Practice Address - Country:US
Practice Address - Phone:402-393-6911
Practice Address - Fax:402-393-7838
Is Sole Proprietor?:No
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist