Individual
BEREVON TAYSHAWN WYATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3510 N OAKLAND AVE STE 206, MILWAUKEE, WI 53211-2746
(414) 915-4213
Mailing address
1727 W KEEFE AVE, MILWAUKEE, WI 53206-2322
(414) 915-4213
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
14485-146
WI
Other
Enumeration date
10/21/2020
Last updated
10/21/2020
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