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General NPI Number Information
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NPI Number | 1932963071
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Entity Type | Individual
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Provider Name | ROBERT LEE WYMBS
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Gender | Male
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Dates
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Enumeration Date | 02/08/2024
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Last Update Date | 02/08/2024
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Provider Practice Location Address
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Address Line | 1355 INDEPENDENCE DR
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City | AUGUSTA
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State | GA
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Zip | 30901-1037
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Country | US
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Telephone | 706-798-1430
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 12683
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City | AUGUSTA
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State | GA
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Zip | 30914-0683
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Country | US
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Telephone | 706-294-7665
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA000674
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License Number State | GA
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