Provider Demographics
NPI:1093751414
Name:WICKARD, JENNIFER (MSPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WICKARD
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 MOHAWK RD
Mailing Address - Street 2:
Mailing Address - City:NEWVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17241-9016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:210 BIG SPRING RD
Practice Address - Street 2:
Practice Address - City:NEWVILLE
Practice Address - State:PA
Practice Address - Zip Code:17241-9497
Practice Address - Country:US
Practice Address - Phone:717-776-8255
Practice Address - Fax:717-776-6266
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012170L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist