Provider Demographics
NPI:1366924201
Name:WILKENS PT, INC.
Entity type:Organization
Organization Name:WILKENS PT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH (KJ)
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILKENS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:620-909-5043
Mailing Address - Street 1:1420 S MAIN
Mailing Address - Street 2:
Mailing Address - City:SCOTT CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67871
Mailing Address - Country:US
Mailing Address - Phone:620-909-5043
Mailing Address - Fax:620-909-5006
Practice Address - Street 1:1420 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SCOTT CITY
Practice Address - State:KS
Practice Address - Zip Code:67871-1948
Practice Address - Country:US
Practice Address - Phone:620-397-1901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-06
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04515261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy