Healthcare Provider Details

I. General information

NPI: 1356824809
Provider Name (Legal Business Name): MARILYN SUE WIKOFF PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2018
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 N CASSADY AVE
BEXLEY OH
43209-1033
US

IV. Provider business mailing address

6988 TOMAHAWK TRL
REYNOLDSBURG OH
43068-4806
US

V. Phone/Fax

Practice location:
  • Phone: 614-246-5093
  • Fax:
Mailing address:
  • Phone: 614-657-4881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number002100
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: