Provider Demographics
NPI:1689791055
Name:WIKE, WILLIAM BRUCE JR (LPTA)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:BRUCE
Last Name:WIKE
Suffix:JR
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2706 FALLSMONT DR
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-2249
Mailing Address - Country:US
Mailing Address - Phone:410-877-0486
Mailing Address - Fax:
Practice Address - Street 1:6000 BELLONA AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-2922
Practice Address - Country:US
Practice Address - Phone:410-323-4277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1474225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant