Healthcare Provider Details

I. General information

NPI: 1144636200
Provider Name (Legal Business Name): GARIN WYBERG PT, DPT, SCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 WEXFORD PLAZA DR
WEXFORD PA
15090-9214
US

IV. Provider business mailing address

4 ALLEGHENY CTR FL 7
PITTSBURGH PA
15212-5255
US

V. Phone/Fax

Practice location:
  • Phone: 724-934-2440
  • Fax: 724-934-2442
Mailing address:
  • Phone: 412-330-5068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT024936
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: