Provider Demographics
NPI:1821156167
Name:WILKINSON, BRIAN JAMES (DPT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:JAMES
Last Name:WILKINSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 WILLAMETTE STREET
Mailing Address - Street 2:STE 302
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401
Mailing Address - Country:US
Mailing Address - Phone:541-357-4536
Mailing Address - Fax:541-653-9669
Practice Address - Street 1:1711 WILLAMETTE STREET
Practice Address - Street 2:STE 302
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-357-4536
Practice Address - Fax:541-653-9669
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT33173225100000X
OR05883225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA056831Medicare ID - Type UnspecifiedREHAB AGENCY