Individual
JONATHON WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
34 GRACEY ST, SPARTA, TN 38583-2046
(931) 836-2211
Mailing address
5233 PLATEAU RD, CROSSVILLE, TN 38571-2036
(931) 787-8091
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
7121
TN
Other
Enumeration date
05/02/2019
Last updated
05/02/2019
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