Provider Demographics
NPI:1083992564
Name:CWIK, JAYME M (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JAYME
Middle Name:M
Last Name:CWIK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 MILL ST
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:WI
Mailing Address - Zip Code:54961-2155
Mailing Address - Country:US
Mailing Address - Phone:888-982-3550
Mailing Address - Fax:920-982-2056
Practice Address - Street 1:1405 MILL ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:WI
Practice Address - Zip Code:54961-2155
Practice Address - Country:US
Practice Address - Phone:888-982-3550
Practice Address - Fax:920-982-2056
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1706-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant