Provider Demographics
NPI:1336648021
Name:WORREL, JOHN WYATT (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WYATT
Last Name:WORREL
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7140 ORIZABA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-2205
Mailing Address - Country:US
Mailing Address - Phone:512-740-0584
Mailing Address - Fax:
Practice Address - Street 1:3225 NE 125TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-4516
Practice Address - Country:US
Practice Address - Phone:206-417-1298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60807487225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist