Provider Demographics
NPI:1396431243
Name:WILKINS, KYLIE (DPT)
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:WILKINS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KYLIE
Other - Middle Name:
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:410-648-4878
Practice Address - Street 1:2033 COLONIAL AVE SW STE 138
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24015-3210
Practice Address - Country:US
Practice Address - Phone:540-466-3981
Practice Address - Fax:540-739-7476
Is Sole Proprietor?:No
Enumeration Date:2023-04-13
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02157500225100000X
VA2305215910225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist