Provider Demographics
NPI:1013250976
Name:WYANT, AMIEE LYN (LMT)
Entity Type:Individual
Prefix:
First Name:AMIEE
Middle Name:LYN
Last Name:WYANT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 S FARRELL DR
Mailing Address - Street 2:SUITE A-110
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-7963
Mailing Address - Country:US
Mailing Address - Phone:760-835-1279
Mailing Address - Fax:
Practice Address - Street 1:340 S FARRELL DR
Practice Address - Street 2:SUITE A-110
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7963
Practice Address - Country:US
Practice Address - Phone:760-835-1279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor