David Shane Wickenden, P.T.

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

014106 Issued in NY

Practice address

22 E 41St St
3Rd Floor
New York, NY 10017-6201

Phone

(212) 686-1112

Fax

(212) 686-1717

NPI assigned

Jul 18, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1245258805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 E 41ST ST",
            "address_2": "3RD FLOOR",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100176201",
            "telephone_number": "212-686-1112",
            "fax_number": "212-686-1717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 E 41ST ST",
            "address_2": "3RD FLOOR",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100176201",
            "telephone_number": "212-686-1112",
            "fax_number": "212-686-1717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKENDEN",
        "first_name": "DAVID",
        "middle_name": "SHANE",
        "credential": "P.T.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "NY",
            "license": "014106",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD ID",
            "identifier": "827482",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET PROVIDER ID",
            "identifier": "ZA1122",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andreas Georg Wibmer, M.D.
• Benjamin Parker Wichman, PT, DPT
• Sarah Wichman, LMSW
• Anthony Christopher Wick, FNP-BC, PMHNP
• Marianne Wickel Schloss, LCSW
• Matthew Adam Wickersham, PHD
• Linda Wickes, PA
• Esme Wickham
• Gay Goodwin Wickham, LPC
• Grayson Wickham

• Orthopedic Physical Therapist in New York, NY
• Providers in New York, NY by specialty
• Orthopedic Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.