Provider Demographics
NPI:1851810451
Name:WICKLER, CAROLINE (DPT)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:WICKLER
Suffix:
Gender:F
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:W277N2666 ROCKY POINT RD
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-4333
Mailing Address - Country:US
Mailing Address - Phone:262-951-5989
Mailing Address - Fax:
Practice Address - Street 1:29650 BRADLEY RD
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92586-6521
Practice Address - Country:US
Practice Address - Phone:951-672-0455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-14
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT293503225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist