Provider Demographics
NPI:1801294376
Name:WILKINSON, NATHAN C
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:C
Last Name:WILKINSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21304 E QUEEN AVE
Mailing Address - Street 2:
Mailing Address - City:OTIS ORCHARDS
Mailing Address - State:WA
Mailing Address - Zip Code:99027-9238
Mailing Address - Country:US
Mailing Address - Phone:509-893-0600
Mailing Address - Fax:509-926-5828
Practice Address - Street 1:213 S UNIVERSITY RD
Practice Address - Street 2:SUITE #3
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-5364
Practice Address - Country:US
Practice Address - Phone:509-893-0600
Practice Address - Fax:509-926-5828
Is Sole Proprietor?:No
Enumeration Date:2014-12-15
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60477303225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist