Individual
ERIC ANDREW WICKLEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPTA
Contact information
Practice address
501 CALDWELL LN, DUNBAR, WV 25064-2026
(304) 744-7064
Mailing address
501 CALDWELL LN, DUNBAR, WV 25064-2026
(304) 744-7064
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
288
WV
Other
Enumeration date
11/21/2012
Last updated
11/21/2012
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