Doctor Name: | CHANTEL JUSTINA WICKHAM |
NPI Number: | 1316380850 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PT |
License Number: | |
Business Practice Address: | 3835 Supreme Ct Nw #2 Bemidji, MN - 566014446 |
Business Phone Number: | 2184448280 |
Business Fax Number: | 2184448337 |
Mailing Address: | 3835 Supreme Ct Nw, #2 BEMIDJI |
State: | MN |
Postal Code: | 566014446 |
Phone Number: | 2184448280 |
Fax Number: | 2184448337 |
NPI Enumeration Date: | 04/15/2013 |
NPI Last Update Date: | 04/15/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
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 |