Provider Demographics
NPI:1053395095
Name:WILKINSON, JOYCE NISHIMOTO (PT)
Entity type:Individual
Prefix:MS
First Name:JOYCE
Middle Name:NISHIMOTO
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15932 HAMLIN ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-6445
Mailing Address - Country:US
Mailing Address - Phone:818-785-0448
Mailing Address - Fax:
Practice Address - Street 1:2664 29TH ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-2916
Practice Address - Country:US
Practice Address - Phone:310-392-8259
Practice Address - Fax:310-392-8274
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12577225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist