Provider Demographics
NPI:1457658510
Name:WICKEL, CHRISTOPHER T (DPT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:T
Last Name:WICKEL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 E 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-1555
Mailing Address - Country:US
Mailing Address - Phone:610-828-7595
Mailing Address - Fax:610-828-7595
Practice Address - Street 1:20 E 11TH AVE
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-1555
Practice Address - Country:US
Practice Address - Phone:610-828-7595
Practice Address - Fax:610-828-7595
Is Sole Proprietor?:No
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist