Healthcare Provider Details

I. General information

NPI: 1013823434
Provider Name (Legal Business Name): WYATT GILBERT PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 E MAIN ST STE C
DUNCAN SC
29334-9839
US

IV. Provider business mailing address

1705 E MAIN ST STE C
DUNCAN SC
29334-9839
US

V. Phone/Fax

Practice location:
  • Phone: 864-485-9960
  • Fax: 821-444-0642
Mailing address:
  • Phone: 864-485-9960
  • Fax: 821-444-0642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13535
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: