Provider Demographics
NPI:1669910113
Name:WILKINSON, TERI (LMT, CPT)
Entity type:Individual
Prefix:
First Name:TERI
Middle Name:
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:LMT, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1970 HANALIMA ST APT P101
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-8911
Mailing Address - Country:US
Mailing Address - Phone:281-733-4483
Mailing Address - Fax:
Practice Address - Street 1:2-2527 KAUMUALII HWY
Practice Address - Street 2:
Practice Address - City:KALAHEO
Practice Address - State:HI
Practice Address - Zip Code:96741-8309
Practice Address - Country:US
Practice Address - Phone:808-332-5580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-04
Last Update Date:2017-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI15037171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor