Wyatt, Berevon Tayshawn

Wyatt, Berevon Tayshawn is an sole proprietor health care provider with primary practice located at 3510 N Oakland Ave Ste 206 , Milwaukee WI 53211-2746. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Massage Therapist, which is considered as his primary health care specialty. Wyatt, Berevon Tayshawn can be contacted via phone (414) 915-4213.

Contact Information

Primary practice address
3510 N Oakland Ave Ste 206 Milwaukee WI 53211-2746
Phone: (414) 915-4213
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Massage Therapist 225700000X 14485-146 Wisconsin

Profile Details

NPI number 1114526068
LBN Legal business name Wyatt, Berevon Tayshawn
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 21st, 2020
Last updated Oct 21st, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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