Provider Demographics
NPI:1922995596
Name:WILHELM, CECIL CLINTON III (MT)
Entity type:Individual
Prefix:MR
First Name:CECIL
Middle Name:CLINTON
Last Name:WILHELM
Suffix:III
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:734 ANTELOPE ST
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-3345
Mailing Address - Country:US
Mailing Address - Phone:970-975-0163
Mailing Address - Fax:
Practice Address - Street 1:697 1675 RD
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-3462
Practice Address - Country:US
Practice Address - Phone:970-985-1491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0027576225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist