MEDICARE: JESSICA N WYKER PT

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
1	225100000X	Physical Therapist	2305214565	VA
2	225100000X	Physical Therapist	CP030284T	CO

General Provider Information

NPI Number	:	1598434011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA N WYKER PT

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:	866-370-8206
Fax Number	:

Provider Business Practice Location Address
First Line	:	2076 S INDEPENDENCE BLVD STE A
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23453-4779
Country	:	US
Telephone Number	:	757-302-4144
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2021
Last Update Date	:	02/05/2026

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