MEDICARE: BRIANA WYATT PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	34703	FL

General Provider Information

NPI Number	:	1265078794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIANA WYATT PT, DPT

Provider Business Mailing Address
First Line	:	8096 PELICAN RD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33967-3464
Country	:	US
Telephone Number	:	630-415-4638
Fax Number	:

Provider Business Practice Location Address
First Line	:	6870 ALISTER WAY
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4535
Country	:	US
Telephone Number	:	239-210-5483
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2019
Last Update Date	:	11/19/2019

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