Provider Demographics
NPI:1154989986
Name:WILKERSON, COURTNEY RENE (PT, DPT)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:RENE
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:PT, DPT
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 36
Mailing Address - Street 2:
Mailing Address - City:CHRISTOVAL
Mailing Address - State:TX
Mailing Address - Zip Code:76935-0036
Mailing Address - Country:US
Mailing Address - Phone:325-716-3110
Mailing Address - Fax:
Practice Address - Street 1:902 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-4077
Practice Address - Country:US
Practice Address - Phone:325-481-7536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1194737225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist