Provider Demographics
NPI:1336361088
Name:WILKINSON, CYNTHIA CLARK (PT)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:CLARK
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 1:22 FOLLY HILL RD
Mailing Address - Street 2:
Mailing Address - City:BUMPASS
Mailing Address - State:VA
Mailing Address - Zip Code:23024-2526
Mailing Address - Country:US
Mailing Address - Phone:804-556-4711
Mailing Address - Fax:
Practice Address - Street 1:115 JEFFERSON HWY
Practice Address - Street 2:SUITE 102
Practice Address - City:LOUISA
Practice Address - State:VA
Practice Address - Zip Code:23093-6563
Practice Address - Country:US
Practice Address - Phone:540-967-1757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305006337225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist