Individual
DAVID SHANE WICKENDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
22 E 41ST ST, 3RD FLOOR, NEW YORK, NY 10017-6201
(212) 686-1112
(212) 686-1717
Mailing address
22 E 41ST ST, 3RD FLOOR, NEW YORK, NY 10017-6201
(212) 686-1112
(212) 686-1717
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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