Provider Demographics
NPI:1770596827
Name:WILKOWSKI, TODD MICHAEL (RPT, OCS)
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:MICHAEL
Last Name:WILKOWSKI
Suffix:
Gender:M
Credentials:RPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 402
Mailing Address - Street 2:
Mailing Address - City:COS COB
Mailing Address - State:CT
Mailing Address - Zip Code:06807-0402
Mailing Address - Country:US
Mailing Address - Phone:203-905-9836
Mailing Address - Fax:
Practice Address - Street 1:35 RIVER RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:COS COB
Practice Address - State:CT
Practice Address - Zip Code:06807-2717
Practice Address - Country:US
Practice Address - Phone:203-422-0679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061490225100000X
CTCT0007440225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD300045271Medicare PIN
NYQ14451Medicare ID - Type UnspecifiedEMPIRE
CT650001222Medicare PIN