| Doctor Name: | MR. KEVIN DOUGLAS WICKS |
| NPI Number: | 1154496412 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT |
| License Number: | PT9887 |
| Business Practice Address: | 3568 Clark Rd Sarasota, FL - 342318408 |
| Business Phone Number: | 9419248868 |
| Business Fax Number: | 9419246670 |
| Mailing Address: | 1721 Old Summerwood Blvd, SARASOTA |
| State: | FL |
| Postal Code: | 342322940 |
| Phone Number: | 9413793343 |
| Fax Number: | 9419246670 |
| NPI Enumeration Date: | 11/22/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT9887 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |