Provider Demographics
NPI:1215072525
Name:WYKES, PATRICK (MA, AT, ATC, PTA)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:WYKES
Suffix:
Gender:M
Credentials:MA, AT, ATC, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 E MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-1366
Mailing Address - Country:US
Mailing Address - Phone:248-875-1097
Mailing Address - Fax:
Practice Address - Street 1:855 E MAIN AVE
Practice Address - Street 2:
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-1366
Practice Address - Country:US
Practice Address - Phone:248-875-1097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer