Robert Wichlacz, MPT

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

5501006967 Issued in MI

Practice address

3041 Charlevoix Dr SE
Grand Rapids, MI 49546-7035

Phone

(616) 942-7200

NPI assigned

Feb 17, 2006

Last updated

Aug 20, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Golan Integrated Physical Medicine

  • Durable Medical Equipment & Medical Supplies
  • Grand Rapids, MI
  • NPI 1952019820
  NPD
• Occupational Rehabilitative Services LLC

  • Physical Therapy Clinic/Center
  • Holland, MI
  • NPI 1669651097

  Physical Therapist

  NPD (past)

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

{
    "created_epoch": "1140134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566259200000",
    "number": "1487629085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3041 CHARLEVOIX DR SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495467035",
            "telephone_number": "616-942-7200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3041 CHARLEVOIX DR SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495467035",
            "telephone_number": "616-942-7200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICHLACZ",
        "first_name": "ROBERT",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-17",
        "last_updated": "2019-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MI",
            "license": "5501006967",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501006967",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOB BCBSMI",
            "identifier": "650G011440",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOB STATE",
            "identifier": "5501006967",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Richelle Nicole Witbrodt Whyte, LPC
• Alanna Joy Wiarda, M.D.
• Gabrielle Wiarda, LMSW
• Hannah Wichern, MPH
• Carolyn Wichlacz, P.T.
• Melissa Wichterman
• Carrie Elizabeth Wicklund, LMSW
• Daniel Francis Wicklund, DNP
• Benjamin Paul Wickman
• Andrew Benjamin Wicks, PT, DPT

• Physical Medicine & Rehabilitation Physician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Physical Medicine & Rehabilitation Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 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.