Provider Demographics
NPI:1295272698
Name:WYATT, BRIANNA PUDNEY (DPT)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:PUDNEY
Last Name:WYATT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 CARMEL EXECUTIVE PARK DR STE 125
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-1309
Mailing Address - Country:US
Mailing Address - Phone:704-379-7773
Mailing Address - Fax:
Practice Address - Street 1:7300 CARMEL EXECUTIVE PARK DR STE 125
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-1309
Practice Address - Country:US
Practice Address - Phone:704-379-7773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-23
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP17083225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist