MEDICARE: TYKARAH PITT WADE LMT

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	225700000X	Massage Therapist
2	175M00000X	Lay Midwife

General Provider Information

NPI Number	:	1285392910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYKARAH PITT WADE LMT

Provider Business Mailing Address
First Line	:	15 GAIL DR APT C
Second Line	:
City	:	NYACK
State	:	NY
Zip	:	10960-1723
Country	:	US
Telephone Number	:	845-689-1540
Fax Number	:

Provider Business Practice Location Address
First Line	:	312 N HIGHLAND AVE
Second Line	:
City	:	NYACK
State	:	NY
Zip	:	10960-1416
Country	:	US
Telephone Number	:	845-689-1540
Fax Number	:

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

Provider Enumeration Date	:	11/30/2021
Last Update Date	:	07/04/2023

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