Provider Demographics
NPI:1497723977
Name:KAU, WYLIE LYNN (DPT)
Entity Type:Individual
Prefix:MR
First Name:WYLIE
Middle Name:LYNN
Last Name:KAU
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4361 LAIRD CIR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054-4199
Mailing Address - Country:US
Mailing Address - Phone:408-771-1108
Mailing Address - Fax:408-654-8082
Practice Address - Street 1:585 N MARY AVE
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085-2905
Practice Address - Country:US
Practice Address - Phone:408-730-5900
Practice Address - Fax:408-730-8722
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27447225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT274471Medicare UPIN