MEDICARE: KYLIE J WAINMAN 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	05013202A	IN

General Provider Information

NPI Number	:	1710476676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLIE J WAINMAN DPT

Provider Business Mailing Address
First Line	:	600 OAKMONT LN STE 600C
Second Line	:
City	:	WESTMONT
State	:	IL
Zip	:	60559-5548
Country	:	US
Telephone Number	:	630-575-6250
Fax Number	:

Provider Business Practice Location Address
First Line	:	1003 MILL POND DR STE C
Second Line	:
City	:	GREENCASTLE
State	:	IN
Zip	:	46135-2609
Country	:	US
Telephone Number	:	765-653-8494
Fax Number	:	765-653-7835

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

Provider Enumeration Date	:	05/07/2018
Last Update Date	:	02/10/2022

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Directions to “ KYLIE J WAINMAN DPT” Practice Location

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