John William Wickenburg, P.T.

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

License

17669 Issued in CA

Practice address

401 Bicentennial Way
Santa Rosa, CA 95403-2149

Phone

(707) 571-4633

NPI assigned

Jan 16, 2007

Last updated

Jul 8, 2007By 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 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1750432597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1684 NORTE WAY",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954042611",
            "telephone_number": "707-525-1988",
            "fax_number": "707-525-1988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 BICENTENNIAL WAY",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954032149",
            "telephone_number": "707-571-4633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKENBURG",
        "first_name": "JOHN",
        "middle_name": "WILLIAM",
        "name_prefix": "Mr.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "CA",
            "license": "17669",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kasia Whiting, PHARMD
• Katherine Whitley
• Gayle Whitlock
• Lucy Whitney
• Derek Edward Whittington, CATC IV
• Margaret Wideau
• Derek Widener, PTA
• Jennifer Widerhorn
• Ellie Rivkah Pritschet Wiener
• Makayla Danielle Wietek

• Case Manager/Care Coordinator in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Case Manager/Care Coordinator in California

• 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.