Provider Demographics
NPI:1700242732
Name:WYLE, SCOTT JOSEPH (DPT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:JOSEPH
Last Name:WYLE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LINEBROOK RD
Mailing Address - Street 2:THE IPSWICH CENTER, INC.
Mailing Address - City:IPSWICH
Mailing Address - State:MA
Mailing Address - Zip Code:01938
Mailing Address - Country:US
Mailing Address - Phone:978-356-4297
Mailing Address - Fax:978-356-5091
Practice Address - Street 1:1 LINEBROOK RD
Practice Address - Street 2:THE IPSWICH CENTER, INC.
Practice Address - City:IPSWICH
Practice Address - State:MA
Practice Address - Zip Code:01938
Practice Address - Country:US
Practice Address - Phone:978-356-4297
Practice Address - Fax:978-356-5091
Is Sole Proprietor?:No
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20928225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist