Provider Demographics
NPI:1962545657
Name:WILCOX, DONALD SPEARS (PT)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:SPEARS
Last Name:WILCOX
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5975 GREENE ROAD 707
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-7825
Mailing Address - Country:US
Mailing Address - Phone:870-236-3287
Mailing Address - Fax:
Practice Address - Street 1:1105 W COURT ST
Practice Address - Street 2:SUITE 1
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4102
Practice Address - Country:US
Practice Address - Phone:870-239-8099
Practice Address - Fax:870-239-5091
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2195225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist