Chantel Justina Wickham, PT

NPI #1316380850 in Bemidji, Minnesota

Provider Information

NPI Number: 1316380850
Entity Type: Individual
Name: Chantel Justina Wickham, PT
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physical Therapist
Credential: PT
Enumeration Date: Apr 15, 2013
Last Updated: Apr 15, 2013

Practice Location

Address: 3835 SUPREME CT NW
Address 2: #2
City: Bemidji
State: Minnesota
ZIP Code: 56601-4446
Phone: (218) 444-8280

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapist	225100000X	Primary

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