Kennan McVey Wyne, D.P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2305210037 Issued in VA

Practice address

500 Irvington Road
Kilmarnock, VA 22482-0128

Phone

(804) 435-3435

Fax

(804) 435-3682

NPI assigned

Mar 31, 2016

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Carousel Physical Therapy, Inc.

  • Specialist
  • Kilmarnock, VA
  • NPI 1568552925

  Physical Therapist

  Medicare reassignment NPD

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

{
    "created_epoch": "1459382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565740800000",
    "number": "1437512175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 IRVINGTON ROAD",
            "address_2": "PO BOX 128",
            "city": "KILMARNOCK",
            "state": "VA",
            "postal_code": "224820128",
            "telephone_number": "804-435-3435",
            "fax_number": "804-435-3682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 IRVINGTON ROAD",
            "city": "KILMARNOCK",
            "state": "VA",
            "postal_code": "224820128",
            "telephone_number": "804-435-3435",
            "fax_number": "804-435-3682"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10880 General Puller Hwy Ste N",
            "address_purpose": "LOCATION",
            "city": "Hartfield",
            "state": "VA",
            "postal_code": "230713140",
            "country_code": "US",
            "telephone_number": "804-776-8500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WYNE",
        "first_name": "KENNAN",
        "middle_name": "MCVEY",
        "credential": "D.P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-31",
        "last_updated": "2019-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305210037",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PT LICENSE",
            "identifier": "2305210037",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lainie Reese Wilson, RBT
• Sara Teagan Wilson
• Brigitte Wolf-Small, M.D.
• Cameron Wood, MD
• Rebecca Gusmus Wright, CPNP
• Your Nurse Next Door, LLC
• Edward A. Zakaib, MD

• Physical Therapist in Kilmarnock, VA
• Providers in Kilmarnock, VA by specialty
• Physical Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.