Provider Demographics
NPI:1821893447
Name:WYMA, JUSTIN HARM (PT DPT NCS)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:HARM
Last Name:WYMA
Suffix:
Gender:M
Credentials:PT DPT NCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 S PARKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3503
Mailing Address - Country:US
Mailing Address - Phone:626-340-5248
Mailing Address - Fax:
Practice Address - Street 1:105 S PARKWOOD AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3503
Practice Address - Country:US
Practice Address - Phone:626-340-5248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT298851225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist