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General NPI Number Information
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NPI Number | 1700335510
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Entity Type | Individual
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Provider Name | MATTHEW WYLAND PT, DPT, OCS
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Gender | Male
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Dates
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Enumeration Date | 09/22/2016
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 603 7TH ST S STE 100
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City | ST PETERSBURG
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State | FL
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Zip | 33701-4719
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Country | US
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Telephone | 727-553-7431
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Fax | 727-553-7432
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Provider Business Mailing Address
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Address Line | 603 7TH ST S STE 100
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City | ST PETERSBURG
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State | FL
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Zip | 33701-4719
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Country | US
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Telephone | 727-553-7431
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Fax | 727-553-7432
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 292008
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 34013
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT4013
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License Number State | FL
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