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General NPI Number Information
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NPI Number | 1043154206
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Entity Type | Individual
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Provider Name | MICHAEL BRADLEY WHICKER
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Gender | Male
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Dates
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Enumeration Date | 04/17/2026
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Last Update Date | 04/17/2026
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Provider Practice Location Address
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Address Line | 1009 STADIUM DR STE 124
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City | WAKE FOREST
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State | NC
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Zip | 27587-4687
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Country | US
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Telephone | 919-453-5910
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Fax | 919-453-5914
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Provider Business Mailing Address
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Address Line | 2122 YORK RD STE 300
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City | OAK BROOK
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State | IL
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Zip | 60523-1925
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Country | US
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Telephone | 570-550-0168
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Fax | 410-648-4878
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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