1215285523 NPI number — AMERICAN THERAPY PROVIDERS, LLC

Table of content: DR. PATRICIA E. WICKS PH.D. (NPI 1538252150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215285523 NPI number — AMERICAN THERAPY PROVIDERS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN THERAPY PROVIDERS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215285523
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8146 BIRCHFIELD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46268-2895
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-755-1773
Provider Business Mailing Address Fax Number:
317-755-1773

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8146 BIRCHFIELD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46268-2895
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-755-1773
Provider Business Practice Location Address Fax Number:
317-755-1773
Provider Enumeration Date:
08/16/2012

Additional Information

Authorized Official

Authorized Official Last Name:
VILLANUEVA
Authorized Official First Name:
RAYMOND
Authorized Official Middle Name:
CORTES
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
317-755-1773

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  05007709A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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