Basic Information
| Provider Information | |||||||||
| NPI: | 1932297041 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WYATT | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 966 N GARDEN RIDGE | ||||||||
| Address2: | SUITE 530 | ||||||||
| City: | LEWISVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724206605 | ||||||||
| FaxNumber: | 9724362770 | ||||||||
| Practice Location | |||||||||
| Address1: | 3501 MIDWAY RD | ||||||||
| Address2: | SUITE 198 | ||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75093 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727812322 | ||||||||
| FaxNumber: | 9727812373 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 08/20/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1108983 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.