| NPI | 1184855058 |
|---|---|
| Former Name | JENNA LEIGH WICKHAM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 28314) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 12600) |
| Enumeration Date | 2009-07-27 |
| Last Update Date | 2022-05-17 |