Provider Demographics
NPI:1922496728
Name:WILKE, AMY G (DPT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:G
Last Name:WILKE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:G
Other - Last Name:CHINNOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:457 N. ELM ST.
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025
Mailing Address - Country:US
Mailing Address - Phone:760-489-1969
Mailing Address - Fax:760-489-5226
Practice Address - Street 1:457 N. ELM ST.
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025
Practice Address - Country:US
Practice Address - Phone:760-489-1969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-31
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
CAPT42080225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14854Medicare UPIN