Organization
WYCHOCK PHYSICAL THERAPY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN G WYCHOCK PHYSICAL THERAPIST (OWNER)
(440) 964-2035
Entity
Organization
Contact information
Practice address
607 LAKE AVE, ASHTABULA, OH 44004-3262
(440) 964-2035
(440) 964-0699
Mailing address
607 LAKE AVE, ASHTABULA, OH 44004-3262
(440) 964-2035
(440) 964-0699
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT006573
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000320301
BLUE CROSS BLUE SHIELD
OH
05
—
2361699
—
OH
01
—
DA9882
RETIRED RAILROAD MEDICARE
OH
Enumeration date
11/20/2007
Last updated
11/20/2007
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