Healthcare Provider Details

I. General information

NPI: 1700335510
Provider Name (Legal Business Name): MATTHEW WYLAND PT, DPT, OCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2016
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 7TH ST S STE 100
ST PETERSBURG FL
33701-4719
US

IV. Provider business mailing address

603 7TH ST S STE 100
ST PETERSBURG FL
33701-4719
US

V. Phone/Fax

Practice location:
  • Phone: 727-553-7431
  • Fax: 727-553-7432
Mailing address:
  • Phone: 727-553-7431
  • Fax: 727-553-7432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number292008
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number34013
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT4013
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: