Provider Demographics
NPI:1003846676
Name:WYATT, COURTLAND (PT)
Entity Type:Individual
Prefix:MR
First Name:COURTLAND
Middle Name:
Last Name:WYATT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6196 OXON HILL RD
Mailing Address - Street 2:STE 120
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3138
Mailing Address - Country:US
Mailing Address - Phone:301-567-6400
Mailing Address - Fax:202-318-8174
Practice Address - Street 1:3700 N CAPITOL ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-8400
Practice Address - Country:US
Practice Address - Phone:800-422-9988
Practice Address - Fax:301-262-1259
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT2863225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist