MEDICARE: PATRICK DAVID WAYLAND RPT

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	PT 25220	CA

General Provider Information

NPI Number	:	1588682132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK DAVID WAYLAND RPT

Provider Business Mailing Address
First Line	:	2342 PROFESSIONAL PARKWAY
Second Line	:	SUITE 110
City	:	SANTA MARIA
State	:	CA
Zip	:	93455
Country	:	US
Telephone Number	:	805-614-0400
Fax Number	:	805-614-0500

Provider Business Practice Location Address
First Line	:	2342 PROFESSIONAL PKWY
Second Line	:	SUITE 110
City	:	SANTA MARIA
State	:	CA
Zip	:	93455-1630
Country	:	US
Telephone Number	:	805-614-0400
Fax Number	:	805-614-0500

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	06/25/2008

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