Provider Demographics
NPI:1952137150
Name:VICK, ANN CHRISTINE (PT)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:CHRISTINE
Last Name:VICK
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:S72W26120 VISTA DEL TIERRA
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-9521
Mailing Address - Country:US
Mailing Address - Phone:262-894-1248
Mailing Address - Fax:
Practice Address - Street 1:3360 GATEWAY RD STE 200
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-5115
Practice Address - Country:US
Practice Address - Phone:414-964-4777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6453-242251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics