Provider Demographics
NPI:1194824854
Name:WIKE, CHRISTINE E (PT)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:E
Last Name:WIKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1426 EUCLID AVE.
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601
Mailing Address - Country:US
Mailing Address - Phone:406-422-1661
Mailing Address - Fax:406-422-1665
Practice Address - Street 1:1426 EUCLID AVE.
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601
Practice Address - Country:US
Practice Address - Phone:406-422-1661
Practice Address - Fax:406-422-1665
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT14812251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT340253Medicaid
MT000084393Medicare ID - Type UnspecifiedMEDICARE GROUP #
MT340253Medicaid
MT000084393Medicare ID - Type UnspecifiedMEDICARE GROUP #