Provider Demographics
NPI:1841051505
Name:WILCZEK, TROY LOUIS (DPT)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:LOUIS
Last Name:WILCZEK
Suffix:
Gender:M
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:PO BOX 1484
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73702-1484
Mailing Address - Country:US
Mailing Address - Phone:405-310-0836
Mailing Address - Fax:405-758-5354
Practice Address - Street 1:900 W CHEROKEE AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5410
Practice Address - Country:US
Practice Address - Phone:580-233-6707
Practice Address - Fax:580-233-3724
Is Sole Proprietor?:No
Enumeration Date:2024-01-19
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5675225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist