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General NPI Number Information
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NPI Number | 1275456907
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Entity Type | Individual
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Provider Name | JENNIFER LYNN WYATT
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Gender | Female
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Dates
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Enumeration Date | 07/31/2026
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Last Update Date | 07/31/2026
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Provider Practice Location Address
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Address Line | 1560 3RD AVE
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City | LONGVIEW
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State | WA
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Zip | 98632-3229
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Country | US
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Telephone | 360-423-9535
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 CORPORATE DR STE 400
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City | HOOVER
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State | AL
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Zip | 35242-5424
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Country | US
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Telephone | 423-238-7217
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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 | PT.PT.70133891
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License Number State | WA
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