MEDICARE: NICHOLAS WYROSDICK DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	6991	MS
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1447865985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS WYROSDICK DPT

Provider Business Mailing Address
First Line	:	PO BOX 306393
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37230-6393
Country	:	US
Telephone Number	:	615-373-1350
Fax Number	:

Provider Business Practice Location Address
First Line	:	5226 AIRLINE RD STE 131
Second Line	:
City	:	ARLINGTON
State	:	TN
Zip	:	38002-9939
Country	:	US
Telephone Number	:	901-441-7997
Fax Number	:	901-881-1577

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2020
Last Update Date	:	04/16/2021

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