Provider Demographics
NPI:1255781035
Name:WILKS, DARIAN (PTA)
Entity type:Individual
Prefix:
First Name:DARIAN
Middle Name:
Last Name:WILKS
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 1:590 E 100 N STE 1
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-2600
Mailing Address - Country:US
Mailing Address - Phone:435-613-1500
Mailing Address - Fax:435-613-1501
Practice Address - Street 1:590 E 100 N STE 1
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-2600
Practice Address - Country:US
Practice Address - Phone:435-613-1500
Practice Address - Fax:435-613-1501
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9675982-2402225200000X
UT96759824201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant