MEDICARE: SARAH THOMSON WYCHE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	823	NC

General Provider Information

NPI Number	:	1083897169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH THOMSON WYCHE

Provider Business Mailing Address
First Line	:	1206 LAKESHORE DR
Second Line	:
City	:	LAKE WACCAMAW
State	:	NC
Zip	:	28450-2145
Country	:	US
Telephone Number	:	910-646-4750
Fax Number	:

Provider Business Practice Location Address
First Line	:	1206 LAKESHORE DR
Second Line	:
City	:	LAKE WACCAMAW
State	:	NC
Zip	:	28450-2145
Country	:	US
Telephone Number	:	910-646-4750
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2007
Last Update Date	:	12/11/2007

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Directions to “ SARAH THOMSON WYCHE ” Practice Location

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