Individual
BLAIRE WYATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, ATC, LAT, CES
Contact information
Practice address
1 UNIVERSITY WAY, SAN ANTONIO, TX 78224-3134
(210) 784-5514
(210) 784-5520
Mailing address
4710 LORELEI DR, SAN ANTONIO, TX 78229-5036
(816) 507-0442
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
5662
TX
Other
Enumeration date
03/07/2018
Last updated
08/30/2021
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