Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT-6573 | OH |
N | 2251E1200X | Ergonomics | PT-6573 | OH |
N | 225XE1200X | Ergonomics | PT-6573 | OH |
N | 2251G0304X | Physical Therapist - Geriatrics | PT-6573 | OH |
N | 2251H1200X | Hand | PT-6573 | OH |
N | 2251N0400X | Physical Therapist - Neurology | PT-6573 | OH |
N | 2251P0200X | Physical Therapist - Pediatrics | PT-6573 | OH |
N | 2251S0007X | Physical Therapist - Sports | PT-6573 | OH |
N | 2251X0800X | Physical Therapist - Orthopedic | PT-6573 | OH |
NPI | 1760489413 |
---|---|
Provider Name | Stephen Gerald Wychock |
First Address | Ashtabula, OH 44004-3262 |
Second Address | Ashtabula, OH 44004-3262 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 04/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000320301 | ANTHEM BC/BS GROUP# (01) | OH |
000000320302 | ANTHEM BC/BS IND# (01) | OH |
200346640-00 | WORKERS' COMP GROUP# (01) | OH |
2160561 | FIRST HEALTH (01) | OH |
233508 | HEALTH AMERICA HEALTH ASS (01) | PA |
2361699 | (05) | OH |
P-12042976 | MULTIPLAN (01) | OH |
Q12591 | (02) | OH |
WY756076 | HIGHMARK BC/BS (01) | PA |
Y08073 | (02) | OH |