BEREVON TAYSHAWN WYATT NPI 1114526068

NPI Information

NPI: 1114526068
Provider Name: BEREVON TAYSHAWN WYATT
Classification: Massage Therapist - 225700000X
Entity Type: Individual
Address:
3510 N OAKLAND AVE STE 206
MILWAUKEE, WI
ZIP 53211
Phone: (414) 915-4213
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Berevon Tayshawn Wyatt is a massage therapist in Milwaukee, WI. The provider is an individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. Berevon Tayshawn Wyatt NPI is 1114526068. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

3510 N OAKLAND AVE STE 206
MILWAUKEE, WI
ZIP 53211-746
Phone: (414) 915-4213

The enumeration date for this NPI number is 10/21/2020 and was last updated on 10/21/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	225700000X	Massage Therapist		14485-146	WISCONSIN	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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