Provider Demographics
NPI:1841224110
Name:WYATT, PATTI A (LMP)
Entity Type:Individual
Prefix:MS
First Name:PATTI
Middle Name:A
Last Name:WYATT
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14650 E LAUREL RD
Mailing Address - Street 2:
Mailing Address - City:ELK
Mailing Address - State:WA
Mailing Address - Zip Code:99009-9641
Mailing Address - Country:US
Mailing Address - Phone:509-292-2466
Mailing Address - Fax:509-292-9672
Practice Address - Street 1:124 E AUGUSTA AVE STE 300
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-2479
Practice Address - Country:US
Practice Address - Phone:509-292-2466
Practice Address - Fax:509-292-9672
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00008483225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist