Individual
DIANA WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10429 TREVINO LN, BENBROOK, TX 76126-4596
(903) 407-0113
Mailing address
10429 TREVINO LN, BENBROOK, TX 76126-4596
(903) 407-0113
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2046449
TX
Other
Enumeration date
09/12/2018
Last updated
09/12/2018
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