Healthcare Provider Details

I. General information

NPI: 1780746123
Provider Name (Legal Business Name): ROSEMARY SWINDLE WYLIE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5720 STONERIDGE MALL RD STE 390
PLEASANTON CA
94588-2831
US

IV. Provider business mailing address

1606 ORVIETO CT
PLEASANTON CA
94566-6494
US

V. Phone/Fax

Practice location:
  • Phone: 925-847-5228
  • Fax:
Mailing address:
  • Phone: 925-484-1187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT10872
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: