Healthcare Provider Details

I. General information

NPI: 1396799953
Provider Name (Legal Business Name): TAMAR WYTE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10736 JEFFERSON BLVD #172
CULVER CITY CA
90230-4969
US

IV. Provider business mailing address

11260 OVERLAND AVE #22A
CULVER CITY CA
90230-5559
US

V. Phone/Fax

Practice location:
  • Phone: 310-936-0224
  • Fax: 310-823-2636
Mailing address:
  • Phone: 310-559-3427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT26482
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: