Active NPI
Michael Gordon Wylie, PHYSICAL THERAPIST
- Physical Therapist
- Blaine, WA
National Provider Identifier
1669671483
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT00005042
- Practice address
- 456 C St
Blaine, WA 98230-4238 - Phone
- (360) 332-8733
- NPI assigned
- Jul 12, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT00005042 | WA | Primary |
Addresses
Primary practice location
456 C St
Blaine, WA 98230-4238
Mailing address
456 C St
Blaine, WA 98230-4238
Phone (360) 332-8733
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT00005042 | WA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184198400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184198400000",
"number": "1669671483",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "456 C ST",
"city": "BLAINE",
"state": "WA",
"postal_code": "982304238",
"telephone_number": "360-332-8733"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "456 C ST",
"city": "BLAINE",
"state": "WA",
"postal_code": "982304238",
"telephone_number": "360-332-8733"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYLIE",
"first_name": "MICHAEL",
"middle_name": "GORDON",
"credential": "PHYSICAL THERAPIST",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-07-12",
"last_updated": "2007-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WA",
"license": "PT00005042",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Blaine, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.