Provider Demographics
NPI:1285392910
Name:PITT WADE, TYKARAH (LMT)
Entity type:Individual
Prefix:
First Name:TYKARAH
Middle Name:
Last Name:PITT WADE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 GAIL DR APT C
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-1723
Mailing Address - Country:US
Mailing Address - Phone:845-689-1540
Mailing Address - Fax:
Practice Address - Street 1:312 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-1416
Practice Address - Country:US
Practice Address - Phone:845-689-1540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-30
Last Update Date:2023-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist