Healthcare Provider Details

I. General information

NPI: 1538222567
Provider Name (Legal Business Name): ROBYN WYZINSKI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 03/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 CHILDRENS WAY
SAN DIEGO CA
92123-4223
US

IV. Provider business mailing address

1000 S BROADWAY APARTMENT #117
DENVER CO
80209-1668
US

V. Phone/Fax

Practice location:
  • Phone: 630-664-3445
  • Fax: 630-994-5023
Mailing address:
  • Phone: 630-664-3445
  • Fax: 630-994-5023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number070-012544
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40054
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0013651
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: