NPIMap

Individual provider Active NPI

Gary Stephen Wick, P.T., A.T.C.

  • Physical Therapist
  • Folsom, CA
National Provider Identifier
1245303742
Registry record updated Sep 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
16017 Issued in CA
Practice address
1675 Creekside Dr.
Ste 101
Folsom, CA 95630
Phone
(916) 939-6800
Fax
(916) 939-6874
NPI assigned
Nov 15, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 5, 2019

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 16017 CA Primary

Addresses

Primary practice location

1675 Creekside Dr.
Ste 101
Folsom, CA 95630

Mailing address

1675 Creekside Dr.
Ste 101
Folsom, CA 95630
Phone (916) 939-6800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
16017CAMDCertified Respiratory Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Body Concepts Inc. Physical Therapist CurrentSince Sep 8, 2019 Accepting new patients
Lynette Rowe Physical Therapy Physical Therapist Past Accepting new patients
Rehabilitation & Occupational Consultants Physical Therapist Past Accepting new patients

Locations

1675 Creekside Dr
Ste 101
Folsom, CA 95630
Phone (916) 939-6800

Organizations & group practices 3

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": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567641600000",
    "number": "1245303742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1675 CREEKSIDE DR.",
            "address_2": "STE 101",
            "city": "FOLSOM",
            "state": "CA",
            "postal_code": "95630",
            "telephone_number": "916-939-6800",
            "fax_number": "916-939-6874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1675 CREEKSIDE DR.",
            "address_2": "STE 101",
            "city": "FOLSOM",
            "state": "CA",
            "postal_code": "95630",
            "telephone_number": "916-939-6800",
            "fax_number": "916-939-6874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICK",
        "first_name": "GARY",
        "middle_name": "STEPHEN",
        "name_prefix": "Mr.",
        "credential": "P.T., A.T.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-15",
        "last_updated": "2019-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "16017",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Folsom, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2019; 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.