Healthcare Provider Details

I. General information

NPI: 1851815534
Provider Name (Legal Business Name): WYE OAK HEALTHCARE OF HYATTSVILLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 03/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4922 LASALLE RD
HYATTSVILLE MD
20782-3302
US

IV. Provider business mailing address

150 ONIX DR
KENNETT SQUARE PA
19348-1886
US

V. Phone/Fax

Practice location:
  • Phone: 484-731-2500
  • Fax: 484-731-1234
Mailing address:
  • Phone: 484-731-2500
  • Fax: 484-731-1234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KAREN LITWA
Title or Position: CFO
Credential:
Phone: 484-731-2500