Provider Demographics
NPI:1568953719
Name:WICKER, NANCY JO (PT)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:JO
Last Name:WICKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:NANCY
Other - Middle Name:JO
Other - Last Name:SCHULTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:18143 SANTA FE LINE RD
Mailing Address - Street 2:
Mailing Address - City:WAYNESFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45896-9425
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:804 S MUMAUGH RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-3569
Practice Address - Country:US
Practice Address - Phone:419-225-9040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-5447225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist