Provider Demographics
NPI:1164937587
Name:PYATT, VICTORIA ELYSE
Entity Type:Individual
Prefix:MISS
First Name:VICTORIA
Middle Name:ELYSE
Last Name:PYATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 HUCK RD
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:OH
Mailing Address - Zip Code:45744-7183
Mailing Address - Country:US
Mailing Address - Phone:740-336-2301
Mailing Address - Fax:
Practice Address - Street 1:1 JOHN MARSHALL DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25755-0002
Practice Address - Country:US
Practice Address - Phone:740-336-2301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-07
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer