Provider Demographics
NPI:1760634901
Name:WILKEN, DEANNA C (PTA)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:C
Last Name:WILKEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 YMCA DR
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-2661
Mailing Address - Country:US
Mailing Address - Phone:636-931-7600
Mailing Address - Fax:636-931-8808
Practice Address - Street 1:1330 YMCA DR
Practice Address - Street 2:SUITE 1200
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-2661
Practice Address - Country:US
Practice Address - Phone:636-931-7600
Practice Address - Fax:636-931-8808
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO116407225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant