Individual
WYATT WHITEGOAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5200 2ND ST NW, WASHINGTON, DC 20011-6622
(202) 223-1111
Mailing address
5200 2ND ST NW, WASHINGTON, DC 20011-6622
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/10/2018
Last updated
08/05/2019
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