Joel Wyckoff, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2006-19 Issued in WI

Practice address

9120 W Capitol Dr
Milwaukee, WI 53222-1622

Phone

(414) 438-3177

Fax

(414) 438-3176

NPI assigned

Jun 6, 2018

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1528243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528243200000",
    "number": "1356833164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 S GREEN BAY RD STE 205",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534064469",
            "telephone_number": "262-898-3930",
            "fax_number": "414-438-3176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9120 W CAPITOL DR",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532221622",
            "telephone_number": "414-438-3177",
            "fax_number": "414-438-3176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYCKOFF",
        "first_name": "JOEL",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-06",
        "last_updated": "2018-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WI",
            "license": "2006-19",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bradley J Wurm, DDS, MS
• Heidi Wurtinger
• Angelina Wyatt-Jolly, RN
• Berevon Tayshawn Wyatt
• Karl Wycklendt
• Mary F Wyman, PH.D.
• Jacob Wynne, M.D.
• Niamh Catherine Wynne, MBBCH
• John C. Wynsen, M.D.
• Maya Wyrzykowski, DO

• Physical Therapy Assistant in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Physical Therapy Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2018; 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.