MEDICARE: KRISTIN L WYMAN PTA

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	225200000X	Physical Therapy Assistant	7768	MA
2	225200000X	Physical Therapy Assistant	3712	NC

General Provider Information

NPI Number	:	1245352798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN L WYMAN PTA

Provider Business Mailing Address
First Line	:	PO BOX 1743
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-1743
Country	:	US
Telephone Number	:	413-822-8828
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 PENNY LN
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-4304
Country	:	US
Telephone Number	:	413-822-8828
Fax Number	:

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

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	07/08/2007

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