Provider Demographics
NPI:1447649173
Name:WYATT, VERRELLE LEE (PT, DPT)
Entity type:Individual
Prefix:
First Name:VERRELLE
Middle Name:LEE
Last Name:WYATT
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 1:1587 BOETTLER RD STE 140
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-7823
Mailing Address - Country:US
Mailing Address - Phone:330-687-6891
Mailing Address - Fax:330-362-2623
Practice Address - Street 1:1587 BOETTLER RD STE 140
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685
Practice Address - Country:US
Practice Address - Phone:330-687-6891
Practice Address - Fax:330-362-2623
Is Sole Proprietor?:No
Enumeration Date:2015-01-19
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.0148452251S0007X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports