Individual
BYRON WILD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
914 15TH ST SE, WASHINGTON, DC 20003-3210
(646) 229-6763
Mailing address
914 15TH ST SE, WASHINGTON, DC 20003-3210
(646) 229-6763
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
2588
DC
Other
Enumeration date
03/11/2020
Last updated
03/11/2020
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