Individual
DEANNA WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, MHS
Contact information
Practice address
80 TEMPLETON DR, OSWEGO, IL 60543-7000
(630) 554-3456
Mailing address
2357 SEQUOIA DR, AURORA, IL 60506-6222
(630) 859-6800
(630) 907-3993
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
070007737
IL
225100000X
Physical Therapist
Primary
070-007737
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04515143
BCBS#
IL
Enumeration date
07/21/2009
Last updated
11/18/2021
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