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General NPI Number Information
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NPI Number | 1265078794
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Entity Type | Individual
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Provider Name | BRIANA WYATT PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 11/19/2019
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Last Update Date | 11/19/2019
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Provider Practice Location Address
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Address Line | 6870 ALISTER WAY
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City | FORT MYERS
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State | FL
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Zip | 33912-4535
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Country | US
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Telephone | 239-210-5483
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Fax |
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Provider Business Mailing Address
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Address Line | 8096 PELICAN RD
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City | FORT MYERS
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State | FL
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Zip | 33967-3464
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Country | US
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Telephone | 630-415-4638
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 34703
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License Number State | FL
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