WYLDE PHYSICAL THERAPY LLC NPI 1740406123

NPI Information

NPI: 1740406123
Provider Name: WYLDE PHYSICAL THERAPY, LLC
Classification: Physical Therapist - 2251X0800X
Specialization: Orthopedic
Entity Type: Organization
Address: 320 W ADAMS ST
WATERMAN, IL
ZIP 60556
Phone: (815) 264-8600

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NPI Details

WYLDE PHYSICAL THERAPY, LLC is an orthopedic physical therapist in Waterman, IL. The provider is a licensed physical therapist, including but not limited to an individual who is a Board Certified Specialist in Orthopaedic Physical Therapy, who has demonstrated specialized knowledge and skill in human anatomy and physiology, movement science; pathology/pathophysiology, pain science, medical and surgical considerations, orthopaedic physical therapy theory and practice, and critical inquiry for evidence-based practice. WYLDE PHYSICAL THERAPY, LLC NPI is 1740406123. The provider is registered as an organization entity type.

The provider's business location address is:

320 W ADAMS ST
WATERMAN, IL
ZIP 60556-000
Phone: (815) 264-8600
Fax: (331) 431-5462

The provider's authorized official is Michele Wylde .
The authorized official title is Owner/physical Therapist and has the following contact phone number (815) 264-8600.

The enumeration date for this NPI number is 4/17/2007 and was last updated on 7/14/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208100000X	Physical Medicine & Rehabilitation				No
2	261QP2000X	Clinic/Center	Physical Therapy			No
3	2251X0800X	Physical Therapist	Orthopedic	070006362	ILLINOIS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1932047	OTHER	ILLINOIS	BCBS GROUP ID#

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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