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Organization
WYMER PHYSICAL THERAPY
Active
Organization
WYMER PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD DANIEL WYMER P.T. (PRESIDENT)
(361) 879-0920
Entity
Organization
Contact information
Practice address
4455 S PADRE ISLAND DR, SUITE 8, CORPUS CHRISTI, TX 78411-5101
(361) 879-0920
(361) 879-0940
Mailing address
4455 S PADRE ISLAND DR, SUITE 8, CORPUS CHRISTI, TX 78411-5101
(361) 879-0920
(361) 879-0940
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1030773
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10779438
CAQH PROVIDER #
TX
05
—
1080186-02
—
TX
01
—
200006701
DEPARTMENT OF LABOR #
TX
01
—
28012
BCBS BLUELINK #
TX
01
—
659504
BCBS PROVIDER #
TX
01
—
B0028012
BCBS UPIN#
TX
Enumeration date
03/20/2007
Last updated
08/13/2010
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