Provider Demographics
NPI:1699781062
Name:WILKINS, MARJORIE B (LPT)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:B
Last Name:WILKINS
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:MARJORIE
Other - Middle Name:
Other - Last Name:ALLISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPT
Mailing Address - Street 1:102 MILE OF CARS WAY
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-6603
Mailing Address - Country:US
Mailing Address - Phone:619-477-7112
Mailing Address - Fax:
Practice Address - Street 1:102 MILE OF CARS WAY
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-6603
Practice Address - Country:US
Practice Address - Phone:619-477-7112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-008162225100000X
CA273852251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208325Medicare ID - Type UnspecifiedMCARE LOC 16
IL208324Medicare ID - Type UnspecifiedMCARE LOC 15