Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | ||
N | 2251S0007X | Physical Therapist - Sports | PT024936 | PA |
NPI | 1144636200 |
---|---|
Provider Name | Dr. Garin Wyberg |
First Address | Pittsburgh, PA 15212-5255 |
Second Address | Wexford, PA 15090-9214 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2014 |
Last Update Date | 19/02/2020 |