Provider Demographics
NPI:1316073893
Name:WYBO, KATHERINE MARY (MPT)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:MARY
Last Name:WYBO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13365 VICTORIA AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070-1720
Mailing Address - Country:US
Mailing Address - Phone:248-765-3153
Mailing Address - Fax:
Practice Address - Street 1:13365 VICTORIA AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON WOODS
Practice Address - State:MI
Practice Address - Zip Code:48070-1720
Practice Address - Country:US
Practice Address - Phone:248-765-3153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010889225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist