Renee Georgette Wickham, MSPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT21160 Issued in FL

Practice address

595 N Courtenay Pkwy
#203
Merritt Island, FL 32953-4851

Phone

(321) 453-8484

Fax

(321) 453-8448

NPI assigned

Feb 26, 2007

Sex

Female

Sole proprietor

Yes

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

State licenses

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

{
    "created_epoch": "1172448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1609902477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "595 N COURTENAY PKWY",
            "address_2": "#203",
            "city": "MERRITT ISLAND",
            "state": "FL",
            "postal_code": "329534851",
            "telephone_number": "321-453-8484",
            "fax_number": "321-453-8448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "595 N COURTENAY PKWY",
            "address_2": "#203",
            "city": "MERRITT ISLAND",
            "state": "FL",
            "postal_code": "329534851",
            "telephone_number": "321-453-8484",
            "fax_number": "321-453-8448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKHAM",
        "first_name": "RENEE",
        "middle_name": "GEORGETTE",
        "name_prefix": "Mrs.",
        "credential": "MSPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT21160",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danielle M Welford
• Jadaisha Wendorf
• Michelle Weyant
• Terry Wharton
• Christine Elaine White, LCSW
• Deborah Wilcox, DOM
• Rachelle Anne Wiley, ARNP
• Irene Tungol Wilkerson
• Chandandeep Singh Wilkhu, DMD
• Susan Willard

• Physical Therapist in Merritt Island, FL
• Providers in Merritt Island, FL by specialty
• Physical Therapist in Florida

• 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.