Provider Demographics
NPI:1417787516
Name:WILCOCK, EMMA BRONWYN (DPT, PT)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:BRONWYN
Last Name:WILCOCK
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:669 FEARRINGTON POST
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312-8523
Mailing Address - Country:US
Mailing Address - Phone:814-441-6542
Mailing Address - Fax:
Practice Address - Street 1:6564 LOISDALE CT STE 500
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-1823
Practice Address - Country:US
Practice Address - Phone:703-822-0039
Practice Address - Fax:703-822-0211
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-05
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
VACP033425T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist