Doctor Name: | DR. JAMIE T WIEKAMP |
NPI Number: | 1639408602 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | DPT 36269 |
License Number: | PT 36269 |
Business Practice Address: | 141 W Wilshire Ave Ste C Fullerton, CA - 928321858 |
Business Phone Number: | 5305188673 |
Business Fax Number: | |
Mailing Address: | 141 W Wilshire Ave, Ste C FULLERTON |
State: | CA |
Postal Code: | 928321858 |
Phone Number: | 5305188673 |
Fax Number: | |
NPI Enumeration Date: | 12/21/2009 |
NPI Last Update Date: | 11/12/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | PT 36269 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |