Provider Demographics
NPI:1487129797
Name:WILKINSON, CHRISTIAN G (PT)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:G
Last Name:WILKINSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 S HARBOR CITY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1936
Mailing Address - Country:US
Mailing Address - Phone:321-725-7225
Mailing Address - Fax:321-802-5811
Practice Address - Street 1:4311 NORFOLK PKWY STE 116
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-8617
Practice Address - Country:US
Practice Address - Phone:321-802-5816
Practice Address - Fax:321-802-5811
Is Sole Proprietor?:No
Enumeration Date:2018-10-12
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT32916225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist