Individual
BRYAN WICKES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
515 MAIN ST, OLEAN, NY 14760-1513
(716) 375-7484
Mailing address
433 GENESEE ST APT 9, OLEAN, NY 14760-1748
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
022143-1
NY
Other
Enumeration date
05/22/2007
Last updated
07/08/2007
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