Provider Demographics
NPI:1861863318
Name:WICHERS, JARED (DPT)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:
Last Name:WICHERS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 N A ST
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-2142
Mailing Address - Country:US
Mailing Address - Phone:864-859-4938
Mailing Address - Fax:864-859-3345
Practice Address - Street 1:712 N A ST
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-2142
Practice Address - Country:US
Practice Address - Phone:864-859-4938
Practice Address - Fax:864-859-3345
Is Sole Proprietor?:No
Enumeration Date:2015-10-09
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 30731225100000X
SC9428225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist