Walter Jordan Wickham, DPT

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

PT-7106 Issued in ID

Practice address

1800 Flandro Dr Ste 190
Pocatello, ID 83202-4940

Phone

(208) 233-2248

NPI assigned

Nov 18, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• McDonald Rehab, PC

  • Physical Therapist
  • Pocatello, ID
  • NPI 1497948509
  NPD

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

{
    "created_epoch": "1605657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605657600000",
    "number": "1346843802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 FLANDRO DR STE 190",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832024940",
            "telephone_number": "208-233-2248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 FLANDRO DR STE 190",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832024940",
            "telephone_number": "208-233-2248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKHAM",
        "first_name": "WALTER",
        "middle_name": "JORDAN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-11-18",
        "last_updated": "2020-11-18",
        "certification_date": "2020-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "ID",
            "license": "PT-7106",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sterling White, PHARMD
• John H Whiting Jr., M.D.
• Donald Maurice Whitley II, PH.D.
• Whole Health Haven
• Rebecca Wickenburg
• Chloe Wilbur
• Ann Wilcox, FNP
• Bonnie M. Wilcox, LSW
• Brandon D Wilde, D.P.M.
• Wildflower Wellness, LLC

• Physical Medicine & Rehabilitation Physician in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Physical Medicine & Rehabilitation Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2020; 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.