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General NPI Number Information
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NPI Number | 1295916146
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Entity Type | Organization
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Legal Business Name | WYCHOCK PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 11/20/2007
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Last Update Date | 11/20/2007
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Provider Practice Location Address
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Address Line | 607 LAKE AVE
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City | ASHTABULA
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State | OH
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Zip | 44004-3262
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Country | US
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Telephone | 440-964-2035
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Fax | 440-964-0699
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Provider Business Mailing Address
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Address Line | 607 LAKE AVE
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City | ASHTABULA
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State | OH
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Zip | 44004-3262
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Country | US
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Telephone | 440-964-2035
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Fax | 440-964-0699
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Authorized Official
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Title or Position | OWNER
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Name | MR. STEPHEN G WYCHOCK
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Credential | PHYSICAL THERAPIST
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Telephone | 440-964-2035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | PT006573
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License Number State | OH
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