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General NPI Number Information
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NPI Number | 1306564299
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Entity Type | Individual
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Provider Name | KRISTIN LAYNE WYATT PT
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Gender | Female
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Dates
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Enumeration Date | 08/17/2022
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Last Update Date | 08/17/2022
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Provider Practice Location Address
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Address Line | 9611 SHERRILL ESTATES RD STE A
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-6504
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Country | US
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Telephone | 980-222-1141
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Fax | 980-220-4010
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Provider Business Mailing Address
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Address Line | 110 WADES WAY APT 305
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City | MOORESVILLE
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State | NC
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Zip | 28117-8764
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Country | US
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Telephone | 919-265-8478
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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 | 21451
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License Number State | NC
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