| NPI | 1164961447 |
|---|---|
| Former Name | AUDREY ANN WICKENS |
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT014631) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV CP015162T) |
| 225100000X Physical Therapist (Licence: WV CP008400T) | |
| Enumeration Date | 2017-02-20 |
| Last Update Date | 2023-10-10 |