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Individual
DAVID SHANE WICKENDEN
Active
Individual
DAVID SHANE WICKENDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
014106
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
827482
OXFORD ID
NY
01
—
ZA1122
HEALTHNET PROVIDER ID
NY
Enumeration date
07/18/2006
Last updated
07/08/2007
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