Individual provider Active NPI

Maryan Nader Wicker, D.P.T

  • Physical Therapist
  • Huntersville, NC
National Provider Identifier
1053704080
Registry record updated Jul 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
P20298 Issued in NC
Practice address
9615 Northcross Center CT Ste B
Huntersville, NC 28078-7300
Phone
(844) 935-3677
Fax
(855) 351-6222
NPI assigned
Mar 16, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X P20298 NC Primary

Addresses

Primary practice location

9615 Northcross Center CT Ste B
Huntersville, NC 28078-7300

Mailing address

9933 Travertine TRL
Davidson, NC 28036-7654
Phone (551) 221-1983

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230706001685 NC Practitioner - Physical Therapist in Private Practice 4183902059 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
40QA01602700NJMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Proactive Therapy of North Carolina Inc Current Accepting new patients
Select Physical Therapy Holdings Inc CurrentSince Oct 1, 2024 Accepting new patients
Select Physical Therapy Holdings Inc CurrentSince Oct 1, 2024 Accepting new patients
Proactive Therapy of North Carolina Inc CurrentSince Apr 23, 2023 Accepting new patients
Proactive Therapy of North Carolina Inc CurrentSince Apr 23, 2023 Accepting new patients
Kessler Institute for Rehabilitation, Inc. Past Accepting new patients
Kessler Institute for Rehabilitation Inc Past Accepting new patients

Locations

60 Livingston St
Ste 400
Asheville, NC 28801
Phone (828) 258-0797

10020 Edison Square Dr NW
Ste C105
Concord, NC 28027
Phone (704) 948-5351

705 Griffith St
Ste 303
Davidson, NC 28036
Phone (704) 894-0166

320 Jake Alexander Blvd W
Ste 106
Salisbury, NC 28147
Phone (704) 636-0052

2358 US Highway 70
Ste Ab
Swannanoa, NC 28778
Phone (828) 686-3375

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1426464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785283200000",
    "number": "1053704080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9933 TRAVERTINE TRL",
            "city": "DAVIDSON",
            "state": "NC",
            "postal_code": "280367654",
            "telephone_number": "551-221-1983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9615 NORTHCROSS CENTER CT STE B",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280787300",
            "telephone_number": "844-935-3677",
            "fax_number": "855-351-6222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKER",
        "first_name": "MARYAN",
        "middle_name": "NADER",
        "credential": "D.P.T",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-16",
        "last_updated": "2026-07-29",
        "certification_date": "2026-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P20298",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntersville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.