Provider Demographics
NPI:1063785194
Name:WILKES, DELANY B (DPT)
Entity type:Individual
Prefix:MR
First Name:DELANY
Middle Name:B
Last Name:WILKES
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 MAIN ST
Mailing Address - Street 2:APT. 1
Mailing Address - City:VEAZIE
Mailing Address - State:ME
Mailing Address - Zip Code:04401-7056
Mailing Address - Country:US
Mailing Address - Phone:207-794-4393
Mailing Address - Fax:
Practice Address - Street 1:12 STILLWATER AVE
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3984
Practice Address - Country:US
Practice Address - Phone:207-945-2946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3808225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist