Provider Demographics
NPI:1245369149
Name:WYMAN, RHYS (MS, RD, LDN)
Entity type:Individual
Prefix:MR
First Name:RHYS
Middle Name:
Last Name:WYMAN
Suffix:
Gender:M
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 RANGE ROAD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087-1805
Mailing Address - Country:US
Mailing Address - Phone:978-474-4478
Mailing Address - Fax:603-894-6961
Practice Address - Street 1:565 TURNPIKE ST STE 64
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5936
Practice Address - Country:US
Practice Address - Phone:978-474-4478
Practice Address - Fax:978-427-6229
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH198133V00000X
MA1582133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAWYMT0174Medicare ID - Type UnspecifiedMEDICARE B PROVIDER NUMBE