Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT.014845 | OH |
N | 2251S0007X | Physical Therapist - Sports | PT.014845 | OH |
NPI | 1447649173 |
---|---|
Provider Name | Verrelle Lee Wyatt |
First Address | Uniontown, OH 44685-7823 |
Second Address | Uniontown, OH 44685 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2015 |
Last Update Date | 16/07/2020 |