Individual
WYATT LEE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
490 HIGHWAY 61, BLOOMSDALE, MO 63627-9131
(573) 483-5040
Mailing address
490 HIGHWAY 61, BLOOMSDALE, MO 63627-9131
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Enumeration date
08/29/2022
Last updated
08/29/2022
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