MEDICARE: WYATT HARPER DIMMICK DPT, PT

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

General Provider Information

NPI Number	:	1548198971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WYATT HARPER DIMMICK DPT, PT

Provider Business Mailing Address
First Line	:	528 WARHAWKS RD
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23322-3531
Country	:	US
Telephone Number	:	757-681-3244
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 PROFESSIONAL PARK DR
Second Line	:
City	:	CONWAY
State	:	SC
Zip	:	29526-9261
Country	:	US
Telephone Number	:	843-353-3460
Fax Number	:

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

Provider Enumeration Date	:	05/13/2026
Last Update Date	:	05/13/2026

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