Individual
KIMBERLY RENE WYATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
3229 BROADWAY ST STE G, NORTH BEND, OR 97459-2203
(541) 751-7979
(541) 751-7877
Mailing address
3229 BROADWAY ST STE G, NORTH BEND, OR 97459-2203
(541) 751-7979
(541) 751-7877
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
10760
OR
Other
Enumeration date
09/11/2009
Last updated
09/11/2009
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