Douglas Bruce Wyatt

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501018165 Issued in MI

Practice address

2570 Jackson Ave Ste C
Ann Arbor, MI 48103-3853

Phone

(734) 823-7820

Fax

(734) 823-7821

NPI assigned

Dec 16, 2018

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

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Athletico LTDGroup PAC ID 4789602681, 2,187 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: douglas.wyatt.p4@direct.athleticoltd.nextgenshare.com

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.

• Athletico LTD

  • Physical Therapist
  • Oak Brook, IL
  • NPI 1821085028

  MI

  Medicare reassignment Care Compare group NPD
• Athletico LTD

  • Clinic/Center
  • Lafayette, IN
  • NPI 1053044867

  Physical Therapist

  NPD
• Botsford General Hospital

  • Urgent Care Clinic/Center
  • Redford, MI
  • NPI 1831402056
  NPD (past)

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

{
    "created_epoch": "1544918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757635200000",
    "number": "1174094437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2122 YORK RD STE 300",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605231925",
            "telephone_number": "630-575-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2570 JACKSON AVE STE C",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481033853",
            "telephone_number": "734-823-7820",
            "fax_number": "734-823-7821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYATT",
        "first_name": "DOUGLAS",
        "middle_name": "BRUCE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-12-16",
        "last_updated": "2025-09-12",
        "certification_date": "2025-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501018165",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Claire Marlow Marriott Wunker, MD
• Benjamin M. Wurtzel, D.D.S.
• Donald John Wurtzel, D.D.S.
• Lindsey Elizabeth Wurtzel, D.D.S
• Kara Jean Wyant, MD
• Montrisha Regina Wyatt, MSW
• Maria Rebecca Wyche, M.A. CCC-SLP
• Jennifer Ann Wyckoff, MD
• Sara Jill Wyczalek, PA-C
• Michael Wyderko, MD

• Physical Therapist in Ann Arbor, MI
• Providers in Ann Arbor, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2025; 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.