Healthcare Provider Details

I. General information

NPI: 1003846676
Provider Name (Legal Business Name): COURTLAND WYATT P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 N CAPITOL ST NW
WASHINGTON DC
20011-8400
US

IV. Provider business mailing address

6196 OXON HILL RD STE 120
OXON HILL MD
20745-3138
US

V. Phone/Fax

Practice location:
  • Phone: 800-422-9988
  • Fax: 301-262-1259
Mailing address:
  • Phone: 301-567-6400
  • Fax: 202-318-8174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT2863
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: