Provider Demographics
NPI:1992055446
Name:WILKES, JOSHUA (MPT)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:WILKES
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 S. STATE STREET
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-2607
Mailing Address - Country:US
Mailing Address - Phone:570-586-2222
Mailing Address - Fax:
Practice Address - Street 1:718 S. STATE STREET
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-2607
Practice Address - Country:US
Practice Address - Phone:570-586-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT022256174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist