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General NPI Number Information
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NPI Number | 1225518129
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Entity Type | Organization
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Legal Business Name | 2WMVT, LLC
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Dates
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Enumeration Date | 08/20/2018
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Last Update Date | 08/20/2018
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Provider Practice Location Address
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Address Line | 203 HERSHINGER RD
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City | CORAOPOLIS
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State | PA
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Zip | 15108-9719
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Country | US
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Telephone | 412-477-2682
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Fax |
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Provider Business Mailing Address
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Address Line | 203 HERSHINGER RD
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City | CORAOPOLIS
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State | PA
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Zip | 15108-9719
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | DR. GARIN K. WYBERG
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Credential | PT, DPT, SCS
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Telephone | 412-477-3742
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | PT024936
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License Number State | PA
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