Individual
MR. GERALD STANLEY WILK JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2077 NW TOWN CENTER DR, BEAVERTON, OR 97006-8938
(360) 910-1840
Mailing address
5841 NE ORENCO GARDENS DR, HILLSBORO, OR 97124-5128
(360) 910-1840
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
14645
OR
225700000X
Massage Therapist
MA 00016097
WA
Other
Enumeration date
09/23/2015
Last updated
09/23/2015
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