Active NPI
Sally Jo Wyatt, LMP
- Specialist
- Port Orchard, WA
National Provider Identifier
1174767412
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- MA60083727
- Practice address
- 1963 Bethel Rd SE
Port Orchard, WA 98366-3108 - Phone
- (360) 876-3393
- NPI assigned
- Apr 30, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | MA60083727 | WA | Primary |
Addresses
Primary practice location
1963 Bethel Rd SE
Port Orchard, WA 98366-3108
Mailing address
PO Box 403
Manchester, WA 98353-0403
Phone (360) 649-4106
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA60083727 | WA | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chiropractic Health Center Inc PS | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Chiropractor
- Gig Harbor, WA
- NPI 1750529160
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1241049600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1265760000000",
"number": "1174767412",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 403",
"city": "MANCHESTER",
"state": "WA",
"postal_code": "983530403",
"telephone_number": "360-649-4106"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1963 BETHEL RD SE",
"city": "PORT ORCHARD",
"state": "WA",
"postal_code": "983663108",
"telephone_number": "360-876-3393"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYATT",
"first_name": "SALLY",
"middle_name": "JO",
"credential": "LMP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-04-30",
"last_updated": "2010-02-10",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "WA",
"license": "MA60083727",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Orchard, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.