Provider Demographics
NPI:1013152313
Name:WILKINSON, THERESA ROCHELLE (PT)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:ROCHELLE
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 W DR MLK BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6529
Mailing Address - Country:US
Mailing Address - Phone:813-973-9229
Mailing Address - Fax:813-973-9228
Practice Address - Street 1:1931 W DR MLK BLVD STE A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6529
Practice Address - Country:US
Practice Address - Phone:813-973-9229
Practice Address - Fax:813-973-9228
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT7092225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT7092OtherGROUP PTAN AL614