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NPI Code Detail

MEDICARE: DARBY WYATT LMT

MEDICARE:   DARBY  WYATT  LMT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage TherapistMA0026086FL

General Provider Information

NPI Number : 1316138357
Entity Type Code : Individual
Provider Name (Legal Business Name) : DARBY WYATT LMT
Provider Business Mailing Address
First Line : 180 WATERFALL WAY UNIT 204
Second Line :
City : ALTAMONTE SPRINGS
State : FL
Zip : 32714-6864
Country : US
Telephone Number : 407-620-9074
Fax Number :
Provider Business Practice Location Address
First Line : 1771 W STATE ROAD 434
Second Line :
City : LONGWOOD
State : FL
Zip : 32750-5067
Country : US
Telephone Number : 407-620-9074
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/06/2007
Last Update Date : 08/06/2007

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Directions to “ DARBY WYATT LMT” Practice Location

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