Healthcare Provider Details

I. General information

NPI: 1184139800
Provider Name (Legal Business Name): AMY C WYKE MS, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2017
Last Update Date: 12/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 FORBES AVE
PITTSBURGH PA
15219-3016
US

IV. Provider business mailing address

600 FORBES AVE AJ PALUMBO CENTER
PITTSBURGH PA
15282-0001
US

V. Phone/Fax

Practice location:
  • Phone: 412-708-3167
  • Fax:
Mailing address:
  • Phone: 412-708-3167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT005908
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: