Provider Demographics
NPI:1184955726
Name:WORMLEY, CAPP WYATT IV (DPT)
Entity type:Individual
Prefix:MR
First Name:CAPP
Middle Name:WYATT
Last Name:WORMLEY
Suffix:IV
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 222342
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93922-2342
Mailing Address - Country:US
Mailing Address - Phone:831-372-3579
Mailing Address - Fax:831-372-3779
Practice Address - Street 1:5 HARRIS CT
Practice Address - Street 2:BUILDING T, SUITE 102
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5750
Practice Address - Country:US
Practice Address - Phone:831-372-3579
Practice Address - Fax:831-372-3779
Is Sole Proprietor?:No
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36424225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA36424OtherPHYSICAL THERAPY BOARD OF CALIFORNIA