Provider Demographics
NPI:1467279422
Name:CROSBY, WYATT
Entity type:Individual
Prefix:
First Name:WYATT
Middle Name:
Last Name:CROSBY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14488 HORSESHOE TRCE
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-8227
Mailing Address - Country:US
Mailing Address - Phone:561-371-0977
Mailing Address - Fax:
Practice Address - Street 1:14488 HORSESHOE TRCE
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-8227
Practice Address - Country:US
Practice Address - Phone:561-371-0977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer