Provider Demographics
NPI:1750529137
Name:DOEBRICK WILKINSON, VALERIE PAIGE (LMT)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:PAIGE
Last Name:DOEBRICK WILKINSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 AUTUMN TRCE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30656-8904
Mailing Address - Country:US
Mailing Address - Phone:678-232-6893
Mailing Address - Fax:
Practice Address - Street 1:332 N BROAD ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-1806
Practice Address - Country:US
Practice Address - Phone:678-232-6893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT004005225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist