Provider Demographics
NPI:1316153786
Name:WYSE, KATIE (PT)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:
Last Name:WYSE
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 1:117 SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-7896
Mailing Address - Country:US
Mailing Address - Phone:832-971-5286
Mailing Address - Fax:
Practice Address - Street 1:616 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-1622
Practice Address - Country:US
Practice Address - Phone:830-331-8840
Practice Address - Fax:830-331-1360
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1153370225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist