Provider Demographics
NPI:1871740407
Name:WICKLINE, JAMES ERIC (MPT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ERIC
Last Name:WICKLINE
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 MCEWEN RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3903
Mailing Address - Country:US
Mailing Address - Phone:937-433-3441
Mailing Address - Fax:
Practice Address - Street 1:7300 MCEWEN RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-3903
Practice Address - Country:US
Practice Address - Phone:937-433-3441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10420225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist