Provider Demographics
NPI:1821571787
Name:WYMER, RACHEL (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:
Last Name:WYMER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 E WADSWORTH PARK DR STE 230
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8096
Mailing Address - Country:US
Mailing Address - Phone:385-308-8034
Mailing Address - Fax:
Practice Address - Street 1:3705 STATE RD # 102
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-5957
Practice Address - Country:US
Practice Address - Phone:440-997-0014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-07
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13090225100000X
IL070.026009225100000X
MD28704225100000X
PAPT029610225100000X
MI5501020216225100000X
MA25790225100000X
FLPT37897225100000X
NY048163225100000X
DCPT200001202225100000X
OH014568225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist