Provider Demographics
NPI:1679546469
Name:WYNIA, STEVEN ERIC (PHYSICALTHERAPISTMPT)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:ERIC
Last Name:WYNIA
Suffix:
Gender:M
Credentials:PHYSICALTHERAPISTMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:13640 OLIVIA CT
Mailing Address - Street 2:
Mailing Address - City:BECKER
Mailing Address - State:MN
Mailing Address - Zip Code:55308-9381
Mailing Address - Country:US
Mailing Address - Phone:763-261-9187
Mailing Address - Fax:
Practice Address - Street 1:5740 BROOKLYN BLVD
Practice Address - Street 2:STE 100
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-3062
Practice Address - Country:US
Practice Address - Phone:763-561-4045
Practice Address - Fax:763-561-8690
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7140225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2015683OtherARAZ PROVIDER #
MN721145700Medicaid
MN416S6WYOtherBCBS PROVIDER #
MNHP41243OtherHEALTH PARTNERS
MN6403670OtherMEDICA PROVIDER #
MN116113OtherU-CARE PROVIDER #
MN6403670OtherMEDICA PROVIDER #