Provider Demographics
NPI:1588682132
Name:WAYLAND, PATRICK DAVID (RPT)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:DAVID
Last Name:WAYLAND
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2342 PROFESSIONAL PARKWAY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455
Mailing Address - Country:US
Mailing Address - Phone:805-614-0400
Mailing Address - Fax:805-614-0500
Practice Address - Street 1:2342 PROFESSIONAL PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-1630
Practice Address - Country:US
Practice Address - Phone:805-614-0400
Practice Address - Fax:805-614-0500
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 25220225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT252200Medicare ID - Type Unspecified