Provider Demographics
NPI:1720153091
Name:WICKS, MEGHAN K (PT)
Entity Type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:K
Last Name:WICKS
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 1:1055 S. TAMIAMI TRAIL
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-9118
Mailing Address - Country:US
Mailing Address - Phone:941-921-5809
Mailing Address - Fax:941-921-5249
Practice Address - Street 1:1055 S. TAMIAMI TRAIL
Practice Address - Street 2:SUITE 105
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-9118
Practice Address - Country:US
Practice Address - Phone:941-921-5809
Practice Address - Fax:941-921-5249
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL168262251X0800X
FLPT16826225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE8348YMedicare ID - Type UnspecifiedMEDICARE NUMBER