Individual
KENNETH WILKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
15201 OLIVE BLVD, CHESTERFIELD, MO 63017-1810
(636) 733-0355
Mailing address
231 N DELLWOOD RD, SAINT LOUIS, MO 63135-2215
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2005037441
MO
Other
Enumeration date
10/07/2021
Last updated
10/07/2021
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