Provider Demographics
NPI:1992751655
Name:WICK, MARY M (MS, PT, ATC)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:M
Last Name:WICK
Suffix:
Gender:F
Credentials:MS, PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8649
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00801-1649
Mailing Address - Country:US
Mailing Address - Phone:340-776-7667
Mailing Address - Fax:
Practice Address - Street 1:9154 ESTATE THOMAS
Practice Address - Street 2:M.M. ELECTRIC BUILDING, LOWER LEVEL
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-2687
Practice Address - Country:US
Practice Address - Phone:340-776-7667
Practice Address - Fax:340-714-1891
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI35225100000X
PAPT-002872225100000X
FLPT-0008750225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI6-2452Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
VIX13832Medicare UPIN