Individual provider Active NPI

Gina Wyatt

  • Physical Therapist
  • Yuma, AZ
National Provider Identifier
1558765321
Registry record updated Mar 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
11157 Issued in AZ
Practice address
2851 S Avenue B
Yuma, AZ 85364-7726
Phone
(800) 391-9477
NPI assigned
Oct 22, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 18, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 11157 AZ Primary

Addresses

Primary practice location

2851 S Avenue B
Yuma, AZ 85364-7726

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20160308001118 VA Practitioner - Physical Therapist in Private Practice 4880918531
I20210317001961 SC Practitioner - Physical Therapist in Private Practice 4880918531 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
RSFH - Ati Physical Therapy LLCGroup PAC ID 3375849946, 98 clinicians

Practice addresses (Care Compare)

1730 Savannah Hwy
Charleston, SC 29407-6255
Phone (843) 763-4115

Merit-based Incentive Payment System (MIPS)

Final score
86.49 of 100Reported as group
Quality
89.43
Improvement activities
40
Cost
74.33

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11157AZMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
RSFH - Ati Physical Therapy, LLC Physical Therapist CurrentSince Feb 22, 2021 Accepting new patients
RSFH - Ati Physical Therapy, LLC Physical Therapist CurrentSince Feb 22, 2021 Accepting new patients
Associated Rehabilitation Physical and Occupational Therapy, PLLC PastSince Dec 13, 2022 Accepting new patients

Locations

790 Remington Blvd
Bolingbrook, IL 60440

33299 Collection Ctr Dr
Chicago, IL 60693

325 Folly Rd
Ste 107
Charleston, SC 29412
Phone (843) 762-0147

1730 Savannah Hwy
Charleston, SC 29407
Phone (843) 763-4115

1941 Savage Rd
Ste 300A
Charleston, SC 29407
Phone (843) 402-1495

180 Wingo Way
Ste 303
Mt Pleasant, SC 29464
Phone (843) 972-0940

9241 University Blvd
Ste B1
North Charleston, SC 29406
Phone (843) 414-1140

5401 Netherby Ln
Ste 300
North Charleston, SC 29420
Phone (843) 225-5211

2070 Northbrook Blvd
Ste A9
North Charleston, SC 29406
Phone (843) 377-0268

1718 State Rd
Ste 7D
Summerville, SC 29486
Phone (843) 303-9418

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1413936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710720000000",
    "number": "1558765321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2851 S AVENUE B",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853647726",
            "telephone_number": "800-391-9477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYATT",
        "first_name": "GINA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-10-22",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "11157",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Yuma, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2024; 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.