Provider Demographics
NPI:1235970344
Name:WYNNE, SYDNEY L (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:SYDNEY
Middle Name:L
Last Name:WYNNE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3711 APPLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-2680
Mailing Address - Country:US
Mailing Address - Phone:989-600-8190
Mailing Address - Fax:
Practice Address - Street 1:1200 WRIGHT AVE
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1133
Practice Address - Country:US
Practice Address - Phone:800-321-9357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501303256225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist