Healthcare Provider Details

I. General information

NPI: 1366628687
Provider Name (Legal Business Name): ADRIENNE LOUISE WYLIE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 CIVIC CENTER BLVD STE 502
YUBA CITY CA
95993-3015
US

IV. Provider business mailing address

1110 CIVIC CENTER BLVD STE 502
YUBA CITY CA
95993-3015
US

V. Phone/Fax

Practice location:
  • Phone: 530-671-7977
  • Fax: 530-671-6163
Mailing address:
  • Phone: 530-671-7977
  • Fax: 530-671-6163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00002569
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: