Phillip Wyatt, RPT
Individual provider Active NPI Physical Therapist · Dover, AR
NPI 1114291648 · NPPES record last updated Mar 1, 2012
Key facts
- NPI
- 1114291648
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT1789 (AR)
- Practice address
- 8952 Market St
Suite 7B
Dover, AR 72837-9110 - Phone
- (479) 331-3303
- NPI assigned
- Mar 1, 2012
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT1789 | AR | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Trilogy Therapy Services, Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT1789 | AR | Yes |
Addresses
Primary practice location
8952 Market St
Suite 7B
Dover, AR 72837-9110
Mailing address
310 Bayou Ridge Loop
Dover, AR 72837-8475
Phone (479) 264-1669
Other providers in Dover, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 1, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.