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NPI Code Detail

MEDICARE: BENJAMIN WICKI DPT

MEDICARE: BENJAMIN WICKI DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist10204CT

General Provider Information

NPI Number : 1053717124
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENJAMIN WICKI DPT
Provider Business Mailing Address
First Line : 30 CHURCH HILL RD
Second Line :
City : NEWTOWN
State : CT
Zip : 06470-1658
Country : US
Telephone Number : 203-426-8449
Fax Number : 203-426-8980
Provider Business Practice Location Address
First Line : 30 CHURCH HILL RD
Second Line :
City : NEWTOWN
State : CT
Zip : 06470-1658
Country : US
Telephone Number : 203-426-8449
Fax Number : 203-426-8980
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2014
Last Update Date : 11/17/2014

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