Kim Michele Wyrwa, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

001703 Issued in GA

Practice address

3615 Braselton Hwy
Ste. 101
Dacula, GA 30019-5906

Phone

(770) 904-0772

Fax

(770) 904-0774

NPI assigned

Jun 20, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Physiotherapy Associates Inc

  • Physical Therapy Clinic/Center
  • Estero, FL
  • NPI 1720039902
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1023213857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2035 WISTERIA CT",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300442891",
            "telephone_number": "770-962-2632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3615 BRASELTON HWY",
            "address_2": "STE. 101",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "300195906",
            "telephone_number": "770-904-0772",
            "fax_number": "770-904-0774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYRWA",
        "first_name": "KIM",
        "middle_name": "MICHELE",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "GA",
            "license": "001703",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jasmine C Williams, PT, DPT
• Yvonne Marie Willis-Bendolph
• Desheal Winfrey, RN
• Women'S Imaging Specialists - Hamilton Mill, LLC
• Constance Elaine Wooden-Smith, LCSW
• Y W B Case Management LLC
• Gau Soua Angelia Yang, PHARMD
• Eunice Mihyun Yi, O.D.
• Tahlee Sylvia Yichye, SLP
• Firas Yosif, DMD

• Physical Therapy Assistant in Dacula, GA
• Providers in Dacula, GA by specialty
• Physical Therapy Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.