Provider Demographics
NPI:1407962327
Name:WYSS, KAREN M (PT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:WYSS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 E 86TH AVE
Mailing Address - Street 2:SUITE J
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6173
Mailing Address - Country:US
Mailing Address - Phone:219-756-2722
Mailing Address - Fax:219-736-2901
Practice Address - Street 1:521 E 86TH AVE
Practice Address - Street 2:SUITE J
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6173
Practice Address - Country:US
Practice Address - Phone:219-756-2722
Practice Address - Fax:219-736-2901
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004039A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200303320Medicaid
IN650021628Medicare PIN
IN216000EMedicare PIN
IN200303320Medicaid
ILK11780Medicare PIN