Provider Demographics
NPI:1801806914
Name:WILKERSON, MARLA NICOLE (PT, CHT)
Entity type:Individual
Prefix:
First Name:MARLA
Middle Name:NICOLE
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:PT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 WESTINGHOUSE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-5238
Mailing Address - Country:US
Mailing Address - Phone:724-343-4060
Mailing Address - Fax:
Practice Address - Street 1:129 LUBRANO DR
Practice Address - Street 2:SUITE 301
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7564
Practice Address - Country:US
Practice Address - Phone:410-224-2626
Practice Address - Fax:410-224-0512
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20757225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist