Provider Demographics
NPI:1992427470
Name:WILKES, DAIJHA (ATC)
Entity type:Individual
Prefix:
First Name:DAIJHA
Middle Name:
Last Name:WILKES
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12524 WISSANT LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-2723
Mailing Address - Country:US
Mailing Address - Phone:314-258-2277
Mailing Address - Fax:
Practice Address - Street 1:209 RUE SAINT LOUIS
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-5025
Practice Address - Country:US
Practice Address - Phone:314-596-2656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer