Provider Demographics
NPI:1518365964
Name:WYRSTA, NADIA
Entity Type:Individual
Prefix:
First Name:NADIA
Middle Name:
Last Name:WYRSTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 PERRY ST
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1846
Mailing Address - Country:US
Mailing Address - Phone:215-704-9816
Mailing Address - Fax:
Practice Address - Street 1:247 PERRY ST
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1846
Practice Address - Country:US
Practice Address - Phone:215-704-9816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist