Healthcare Provider Details

I. General information

NPI: 1407962327
Provider Name (Legal Business Name): KAREN M WYSS P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 E 86TH AVE SUITE J
MERRILLVILLE IN
46410-6173
US

IV. Provider business mailing address

521 E 86TH AVE SUITE J
MERRILLVILLE IN
46410-6173
US

V. Phone/Fax

Practice location:
  • Phone: 219-756-2722
  • Fax: 219-736-2901
Mailing address:
  • Phone: 219-756-2722
  • Fax: 219-736-2901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05004039A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: