Healthcare Provider Details

I. General information

NPI: 1851704704
Provider Name (Legal Business Name): BRITTANY WYCOFF P.T., D.P.T
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12184 LAKE UNDERHILL RD
ORLANDO FL
32825-5012
US

IV. Provider business mailing address

1309 WATERFORD OAK DR #302
ORLANDO FL
32828-5971
US

V. Phone/Fax

Practice location:
  • Phone: 407-382-3777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number29290
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: