Provider Demographics
NPI:1851452015
Name:WICAL, JOY MARIE (PT)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:MARIE
Last Name:WICAL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8328 W AVENUE E12
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-7012
Mailing Address - Country:US
Mailing Address - Phone:661-728-0146
Mailing Address - Fax:
Practice Address - Street 1:44303 LOWTREE AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4149
Practice Address - Country:US
Practice Address - Phone:661-940-5494
Practice Address - Fax:661-940-0825
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 147612251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic