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General NPI Number Information
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NPI Number | 1073426532
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Entity Type | Individual
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Provider Name | WYATT GRAUPE LMT
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Gender | Male
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Dates
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Enumeration Date | 09/25/2026
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Last Update Date | 09/25/2026
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Provider Practice Location Address
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Address Line | 1916 24TH AVE
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City | GULFPORT
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State | MS
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Zip | 39501-2975
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Country | US
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Telephone | 228-313-9208
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Fax |
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Provider Business Mailing Address
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Address Line | 15329 JOHN SMITH RD
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City | VANCLEAVE
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State | MS
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Zip | 39565-7969
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Country | US
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Telephone | 228-424-3249
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State | MS
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