David Ralph Wycoff

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1528 Issued in OK

Practice address

4812 E 33Rd St
Tulsa, OK 74135-2038

Phone

(918) 622-4126

Fax

(918) 270-2398

NPI assigned

Aug 11, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340150400000",
    "number": "1083625388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3922 S FLORENCE AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741053728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4812 E 33RD ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741352038",
            "telephone_number": "918-622-4126",
            "fax_number": "918-270-2398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYCOFF",
        "first_name": "DAVID",
        "middle_name": "RALPH",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-11",
        "last_updated": "2012-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OK",
            "license": "1528",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID  LEGACY",
            "identifier": "100834750A",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE LEGACY",
            "identifier": "243631709",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS LEGACY",
            "identifier": "892690007003",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA LEGACY",
            "identifier": "4581366",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100834750A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rebecca Ann Wyatt, DDS
• Robin Gayle Wyatt
• Wayne Nolan Wyatt, DDS MS
• Ashley Lynn Duvall Wyckoff, NBCC
• Carol M Wycoff, P.T.
• Sacha Wren Wycoff, RN
• Georgia A. Wykoff, LCSW
• William P. Wylie, D.O.
• Michael Wynn, DDS
• Tiffanie Wynn

• Physical Therapist in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Physical Therapist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2012; 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.