NPI | 1164961447 |
---|---|
Former Name | AUDREY ANN WICKENS |
Entity Type | Individual |
Gender | Female |
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 |