Dominique E Wynn, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

25685 Issued in CA

Practice address

375 Macarthur Ave
# 2
Long Branch, NJ 07740-7649

Phone

(415) 846-0395

NPI assigned

Sep 19, 2007

Last updated

Oct 14, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Enrolled in NJ

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Coastal Home Rehabilitation, LLCGroup PAC ID 0345418646, 50 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Coastal Home Rehabilitation, LLC

  • Multi-Specialty Clinic/Center
  • Belmar, NJ
  • NPI 1316236664

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• Highline Physical Therapy

  dba Highline Physical Therapy & Sports Rehabilitation

  • Physical Therapist
  • Cardiff by the Sea, CA
  • NPI 1831897123
  NPD (past)

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

{
    "created_epoch": "1190160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571011200000",
    "number": "1063608594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 MACARTHUR AVE",
            "address_2": "# 2",
            "city": "LONG BRANCH",
            "state": "NJ",
            "postal_code": "077407649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 MACARTHUR AVE",
            "address_2": "# 2",
            "city": "LONG BRANCH",
            "state": "NJ",
            "postal_code": "077407649",
            "telephone_number": "415-846-0395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYNN",
        "first_name": "DOMINIQUE",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-19",
        "last_updated": "2019-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "25685",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• August Wreiole, MD
• Christian Wreiole, L.P.C.
• Paul Thomas Wright, LCADC
• Xiyi Wu, MD
• Danielle Deriggi Wurzburger
• Shang Xiang, OD
• Karan Jayeshkumar Yagnik, MD
• Pavan Kumar Yalamanchili
• Denise Yaman, NP
• Ece Yilmaz, ND

• Physical Therapist in Long Branch, NJ
• Providers in Long Branch, NJ by specialty
• Physical Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.