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General NPI Number Information
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NPI Number | 1518161231
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Entity Type | Individual
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Provider Name | JESSICA M WICK DPT, CHT
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Gender | Female
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Dates
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Enumeration Date | 06/14/2007
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 2553 E DRAKE ST
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City | GILBERT
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State | AZ
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Zip | 85234-1118
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Country | US
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Telephone | 314-413-1529
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Fax | 480-813-7901
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Provider Business Mailing Address
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Address Line | 2553 E DRAKE ST
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City | GILBERT
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State | AZ
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Zip | 85234-1118
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Country | US
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Telephone | 314-413-1529
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Fax |
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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 | LPT-008611
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License Number State | AZ
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