Organization
WYLDE PHYSICAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELE WYLDE (OWNER/PHYSICAL THERAPIST)
(815) 264-8600
Entity
Organization
Contact information
Practice address
320 W ADAMS ST, WATERMAN, IL 60556-4000
(815) 264-8600
(331) 431-5462
Mailing address
PO BOX 98, WATERMAN, IL 60556-0098
(815) 264-8600
(331) 431-5462
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2251X0800X
Orthopedic Physical Therapist
Primary
070006362
IL
261QP2000X
Physical Therapy Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1932047
BCBS GROUP ID#
IL
Enumeration date
04/17/2007
Last updated
07/14/2025
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