Individual
MARSHA R WYKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, OCS, CERT. MDT
Contact information
Practice address
112 ETNA RD, LEBANON, NH 03766-1454
(603) 643-7788
(603) 643-0022
Mailing address
PO BOX 727, LEBANON, NH 03766-0727
(603) 643-7788
(603) 643-0022
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3473
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001273001
MEDICARE PTAN
NH
05
—
1016880
—
VT
05
—
30397715
—
NH
Enumeration date
07/21/2006
Last updated
03/17/2018
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