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General NPI Number Information
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NPI Number | 1285392910
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Entity Type | Individual
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Provider Name | TYKARAH PITT WADE LMT
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Gender | Female
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Dates
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Enumeration Date | 11/30/2021
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Last Update Date | 07/04/2023
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Provider Practice Location Address
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Address Line | 312 N HIGHLAND AVE
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City | NYACK
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State | NY
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Zip | 10960-1416
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Country | US
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Telephone | 845-689-1540
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Fax |
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Provider Business Mailing Address
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Address Line | 15 GAIL DR APT C
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City | NYACK
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State | NY
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Zip | 10960-1723
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Country | US
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Telephone | 845-689-1540
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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 |
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Taxonomy #2
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Taxonomy Code | 175M00000X
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Taxonomy Name | Lay Midwife
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License Number |
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License Number State |
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