Provider Demographics
NPI:1982360178
Name:WYSS, JAMES MATTHEW (PTA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MATTHEW
Last Name:WYSS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 W EVERGREEN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6970
Mailing Address - Country:US
Mailing Address - Phone:907-745-8686
Mailing Address - Fax:
Practice Address - Street 1:304 W EVERGREEN AVE STE 101
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6970
Practice Address - Country:US
Practice Address - Phone:907-745-8686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-11
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK187135225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant