NPIMap

Individual provider Active NPI

Richard Joseph Wickstrom, PT, DPT, CPE, CDMS

  • Ergonomics Physical Therapist
  • West Chester, OH
National Provider Identifier
1922387745
Registry record updated Aug 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ergonomics Physical TherapistTaxonomy code 2251E1200X
License
3582 Issued in OH
Practice address
7665 Monarch CT
Suite 109
West Chester, OH 45069-2497
Phone
(513) 821-7420
Fax
(513) 672-2552
NPI assigned
Aug 10, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2011

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Ergonomics Physical Therapist 2251E1200X 3582 OH Primary
Ergonomics Physical Therapist 2251E1200X 001690 KY
Ergonomics Physical Therapist 2251E1200X 05009555A IN

Addresses

Primary practice location

7665 Monarch CT
Suite 109
West Chester, OH 45069-2497

Mailing address

7665 Monarch CT
Suite 109
West Chester, OH 45069-2497
Phone (513) 821-7420

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
05009555AINMDErgonomics Physical Therapist
001690KYMDErgonomics Physical Therapist
3582OHMDErgonomics Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Workability Systems, Inc. Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1312934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312934400000",
    "number": "1922387745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7665 MONARCH CT",
            "address_2": "SUITE 109",
            "city": "WEST CHESTER",
            "state": "OH",
            "postal_code": "450692497",
            "telephone_number": "513-821-7420",
            "fax_number": "513-672-2552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7665 MONARCH CT",
            "address_2": "SUITE 109",
            "city": "WEST CHESTER",
            "state": "OH",
            "postal_code": "450692497",
            "telephone_number": "513-821-7420",
            "fax_number": "513-672-2552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKSTROM",
        "first_name": "RICHARD",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "PT, DPT, CPE, CDMS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-08-10",
        "last_updated": "2011-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251E1200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Ergonomics",
            "state": "OH",
            "license": "3582",
            "primary": true
        },
        {
            "code": "2251E1200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Ergonomics",
            "state": "KY",
            "license": "001690",
            "primary": false
        },
        {
            "code": "2251E1200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Ergonomics",
            "state": "IN",
            "license": "05009555A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Chester, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2011; 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.