Provider Demographics
NPI:1780746123
Name:WYLIE, ROSEMARY SWINDLE (PT)
Entity type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:SWINDLE
Last Name:WYLIE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 ORVIETO CT
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-6494
Mailing Address - Country:US
Mailing Address - Phone:925-484-1187
Mailing Address - Fax:
Practice Address - Street 1:5720 STONERIDGE MALL RD STE 390
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-2831
Practice Address - Country:US
Practice Address - Phone:925-847-5228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10872225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist