Provider Demographics
NPI:1265525638
Name:WILKERSON, ANJANA (PT)
Entity type:Individual
Prefix:
First Name:ANJANA
Middle Name:
Last Name:WILKERSON
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 1:1809 EAST DYER RD
Mailing Address - Street 2:SUITE 311
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705
Mailing Address - Country:US
Mailing Address - Phone:949-863-0022
Mailing Address - Fax:949-863-0023
Practice Address - Street 1:2550 E AMA ROAD
Practice Address - Street 2:SUITE A1B
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792
Practice Address - Country:US
Practice Address - Phone:626-337-6335
Practice Address - Fax:626-337-6365
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT259B7225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WPT25987AOtherPPIN
PT25987Medicare ID - Type Unspecified