Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 00907 | OR |
NPI | 1669894275 |
---|---|
Provider Name | Janell Wyatt |
First Address | Dufur, OR 97021-0161 |
Second Address | The Dalles, OR 97058-3317 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2014 |
Last Update Date | 16/01/2014 |