Provider Demographics
NPI:1730326455
Name:VAN WYCK, BARBARA K (PT)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:K
Last Name:VAN WYCK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-3432
Mailing Address - Country:US
Mailing Address - Phone:317-439-8032
Mailing Address - Fax:
Practice Address - Street 1:200 WOOD AVE
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-3432
Practice Address - Country:US
Practice Address - Phone:317-439-8032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-16
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2346225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist