Individual
MRS. CAROLYN WICHLACZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
1471 GRACE ST SE, GRAND RAPIDS, MI 49506-1678
(616) 913-2006
(616) 913-2005
Mailing address
1471 GRACE ST SE, GRAND RAPIDS, MI 49506-1678
(616) 913-2006
(616) 913-2005
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501006957
MI
Other
Enumeration date
08/07/2012
Last updated
08/07/2012
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