Provider Demographics
NPI:1932297041
Name:WYATT, JULIE J (PT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:J
Last Name:WYATT
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:966 N GARDEN RIDGE
Mailing Address - Street 2:SUITE 530
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077
Mailing Address - Country:US
Mailing Address - Phone:972-420-6605
Mailing Address - Fax:972-436-2770
Practice Address - Street 1:3501 MIDWAY RD
Practice Address - Street 2:SUITE 198
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093
Practice Address - Country:US
Practice Address - Phone:972-781-2322
Practice Address - Fax:972-781-2373
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2009-08-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX1108983225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84P589Medicare PIN