Individual
WADE WYCKOFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1111 LINE AVE, SHREVEPORT, LA 71101-3841
(318) 716-4545
Mailing address
1111 LINE AVE, SHREVEPORT, LA 71101-3841
(318) 716-4545
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
346157
LA
Other
Enumeration date
06/20/2021
Last updated
10/14/2025
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