Individual
MARLYN BRIAN WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT, RN
Contact information
Practice address
845 SULLIVAN AVE, FARMINGTON, NM 87401-7356
(505) 278-8295
(505) 436-2077
Mailing address
845 SULLIVAN AVE, FARMINGTON, NM 87401-7356
(505) 278-8295
(505) 436-2077
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT5774
NM
Other
Enumeration date
01/23/2020
Last updated
04/16/2021
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