Individual
KALLIE A WIKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
100 E 33RD ST STE 204, VANCOUVER, WA 98663
(360) 823-0138
Mailing address
1480 NE VILLAGE ST, FAIRVIEW, OR 97024-3827
(503) 489-1174
(503) 489-1650
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
PT294922
CA
225100000X
Physical Therapist
Primary
PT60989646
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT294922
PT LICENSE
CA
Enumeration date
06/26/2018
Last updated
09/26/2019
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