Provider Type Icon

WYLDE PHYSICAL THERAPY LLC NPI 1740406123


NPI Information

NPI: 1740406123
Provider Name: WYLDE PHYSICAL THERAPY, LLC
Classification: Physical Therapist - 2251X0800X
Entity Type: Organization

Specialization: Orthopedic

Address:
125 N. CEDAR ST
WATERMAN, IL
ZIP 60556
Phone: (815) 264-8600
Get Directions

WYLDE PHYSICAL THERAPY, LLC is an orthopedic physical therapist in Waterman, IL. The provider is a licensed physical therapist, including but not limited to an individual who is a Board Certified Specialist in Orthopaedic Physical Therapy, who has demonstrated specialized knowledge and skill in human anatomy and physiology, movement science; pathology/pathophysiology, pain science, medical and surgical considerations, orthopaedic physical therapy theory and practice, and critical inquiry for evidence-based practice. WYLDE PHYSICAL THERAPY, LLC NPI is 1740406123. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

125 N. CEDAR ST
WATERMAN, IL
ZIP 60556
Phone: (815) 264-8600
Fax: (815) 264-8644

The provider's authorized official is Michele Wylde .
The authorized official title is Owner/physical Therapist and has the following contact phone number (815) 264-8600.

The enumeration date for this NPI number is 4/17/2007 and was last updated on 8/6/2018.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12251X0800XPhysical TherapistOrthopedic070006362ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11932047OTHERILLINOISBCBS GROUP ID#

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.