Provider Demographics
NPI:1306806393
Name:WILCOX, DENISE THOMAS (PT OD PHD)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:THOMAS
Last Name:WILCOX
Suffix:
Gender:F
Credentials:PT OD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 S MALLARD LN
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18902-1281
Mailing Address - Country:US
Mailing Address - Phone:215-340-9737
Mailing Address - Fax:215-340-9559
Practice Address - Street 1:RTE 313 AND 611
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901
Practice Address - Country:US
Practice Address - Phone:215-348-3127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001012152W00000X
PAPT000487E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10563790002Medicaid
PAT30388Medicare UPIN
430312Medicare ID - Type Unspecified