Provider Demographics
NPI:1639334634
Name:WICAL, CRAIG JAMES
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:JAMES
Last Name:WICAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12201 OSPREY DR. NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-2470
Mailing Address - Country:US
Mailing Address - Phone:206-679-8880
Mailing Address - Fax:
Practice Address - Street 1:1010 S 336TH ST STE 210
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-7354
Practice Address - Country:US
Practice Address - Phone:253-835-8091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-19
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant