Provider Demographics
NPI:1831105832
Name:WILES, JERALD MITCHELL JR (PT)
Entity Type:Individual
Prefix:MR
First Name:JERALD
Middle Name:MITCHELL
Last Name:WILES
Suffix:JR
Gender:M
Credentials:PT
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Mailing Address - Street 1:1915 WEST PARK DRIVE
Mailing Address - Street 2:PHYSICAL THERAPY ASSOCIATES OF WILKES LLC STE 102
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659
Mailing Address - Country:US
Mailing Address - Phone:336-903-9293
Mailing Address - Fax:336-903-9295
Practice Address - Street 1:1915 WEST PARK DRIVE
Practice Address - Street 2:PHYSICAL THERAPY ASSOCIATES OF WILKES LLC STE 102
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659
Practice Address - Country:US
Practice Address - Phone:336-903-9293
Practice Address - Fax:336-903-9295
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NC2266225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7201007Medicaid
NC7201007Medicaid