Provider Demographics
NPI:1245220367
Name:WICINSKI, MARGARET A (PT DPT MTC PCC)
Entity Type:Individual
Prefix:MISS
First Name:MARGARET
Middle Name:A
Last Name:WICINSKI
Suffix:
Gender:F
Credentials:PT DPT MTC PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:756 HIGHLANDER POINT DR
Mailing Address - Street 2:
Mailing Address - City:FLOYDS KNOBS
Mailing Address - State:IN
Mailing Address - Zip Code:47119-9682
Mailing Address - Country:US
Mailing Address - Phone:812-923-0630
Mailing Address - Fax:812-923-0632
Practice Address - Street 1:756 HIGHLANDER POINT DR
Practice Address - Street 2:
Practice Address - City:FLOYDS KNOBS
Practice Address - State:IN
Practice Address - Zip Code:47119-9682
Practice Address - Country:US
Practice Address - Phone:812-923-0630
Practice Address - Fax:812-923-0632
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007876A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN197710Medicare ID - Type Unspecified