Individual
MR. DAVID RALPH WYCOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1528
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100834750A
MEDICAID LEGACY
—
05
—
100834750A
—
OK
01
—
243631709
MEDICARE LEGACY
—
01
—
4581366
AETNA LEGACY
—
01
—
892690007003
BCBS LEGACY
—
Enumeration date
08/11/2006
Last updated
06/20/2012
Update your record
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