Provider Demographics
NPI:1225877202
Name:WICKETT, SHAYLA MARIE (DPT)
Entity type:Individual
Prefix:
First Name:SHAYLA
Middle Name:MARIE
Last Name:WICKETT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1791
Mailing Address - Street 2:15 SAGE HILL RD
Mailing Address - City:GLENROCK
Mailing Address - State:WY
Mailing Address - Zip Code:82637-1791
Mailing Address - Country:US
Mailing Address - Phone:307-262-4212
Mailing Address - Fax:
Practice Address - Street 1:1541 CENTENNIAL CT
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-7304
Practice Address - Country:US
Practice Address - Phone:307-235-3910
Practice Address - Fax:307-266-2891
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT-2391225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist