Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | ||
N | 2251H1300X | Human Factors | ||
N | 225XH1300X | Human Factors | ||
N | 2251N0400X | Physical Therapist - Neurology | ||
N | 2251P0200X | Physical Therapist - Pediatrics | ||
N | 2251S0007X | Physical Therapist - Sports | ||
N | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1629146089 |
---|---|
Provider Name | Michelle Wyrick |
First Address | Gardner, KS 66030-1819 |
Second Address | Olathe, KS 66062-3367 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2006 |
Last Update Date | 15/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
37328011 | BLUE CROSS BLUE SHIELD (01) | |
481452209 | (05) | MO |