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General NPI Number Information
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NPI Number | 1003931288
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Entity Type | Organization
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Legal Business Name | WYMER PHYSICAL THERAPY
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 08/13/2010
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Provider Practice Location Address
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Address Line | 4455 S PADRE ISLAND DR SUITE 8
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City | CORPUS CHRISTI
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State | TX
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Zip | 78411-5101
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Country | US
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Telephone | 361-879-0920
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Fax | 361-879-0940
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Provider Business Mailing Address
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Address Line | 4455 S PADRE ISLAND DR SUITE 8
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City | CORPUS CHRISTI
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State | TX
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Zip | 78411-5101
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Country | US
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Telephone | 361-879-0920
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Fax | 361-879-0940
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RICHARD DANIEL WYMER
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Credential | P.T.
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Telephone | 361-879-0920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1030773
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License Number State | TX
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