Individual
MALLORY WILKENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
550 LANCASTER ST APT 1, JACKSONVILLE, FL 32204-4113
(205) 948-7755
Mailing address
550 LANCASTER ST APT 1, JACKSONVILLE, FL 32204-4113
(205) 948-7755
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
PTA 24485
FL
225200000X
Physical Therapy Assistant
Primary
PTA003193
GA
Other
Enumeration date
12/06/2013
Last updated
12/06/2013
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