MEDICARE: WYATT JAMES KIPP DPT

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	4332	NE

General Provider Information

NPI Number	:	1144951864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WYATT JAMES KIPP DPT

Provider Business Mailing Address
First Line	:	1268 E HENRY ST STE 1
Second Line	:
City	:	LOUISVILLE
State	:	NE
Zip	:	68037-7025
Country	:	US
Telephone Number	:	402-234-3333
Fax Number	:

Provider Business Practice Location Address
First Line	:	1268 E HENRY ST STE 1
Second Line	:
City	:	LOUISVILLE
State	:	NE
Zip	:	68037-7025
Country	:	US
Telephone Number	:	402-234-3333
Fax Number	:	844-272-6479

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

Provider Enumeration Date	:	06/22/2022
Last Update Date	:	04/16/2026

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