Provider Demographics
NPI:1356108898
Name:SCHICKLER, JACK (DPT, PT)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:SCHICKLER
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1217
Mailing Address - Country:US
Mailing Address - Phone:718-938-7365
Mailing Address - Fax:
Practice Address - Street 1:5709 HAMLIN AVE
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-9210
Practice Address - Country:US
Practice Address - Phone:360-384-5171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist