Provider Demographics
NPI:1316484736
Name:WICHMAN, TARO (PT, DPT, MTC)
Entity type:Individual
Prefix:DR
First Name:TARO
Middle Name:
Last Name:WICHMAN
Suffix:
Gender:M
Credentials:PT, DPT, MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 770211
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77215-0211
Mailing Address - Country:US
Mailing Address - Phone:832-620-1225
Mailing Address - Fax:
Practice Address - Street 1:7777 SOUTHWEST FWY
Practice Address - Street 2:SUITE #640
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1802
Practice Address - Country:US
Practice Address - Phone:713-270-0477
Practice Address - Fax:713-270-7655
Is Sole Proprietor?:No
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1272156225100000X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports