Wyatt Blue, MS, LAT, ATC, CSCS

Primary specialty

ContractorTaxonomy code 171W00000X

License

0506246 Issued in NV

Practice address

1732 Mackinnon Ave
Cardiff by the Sea, CA 92007-1605

Phone

(603) 812-6913

NPI assigned

Apr 3, 2013

Last updated

Jan 16, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1364947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389830400000",
    "number": "1346583754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1732 MACKINNON AVE",
            "city": "CARDIFF BY THE SEA",
            "state": "CA",
            "postal_code": "920071605",
            "telephone_number": "603-812-6913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1732 MACKINNON AVE",
            "city": "CARDIFF BY THE SEA",
            "state": "CA",
            "postal_code": "920071605",
            "telephone_number": "603-812-6913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLUE",
        "first_name": "WYATT",
        "name_prefix": "Mr.",
        "credential": "MS, LAT, ATC, CSCS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-04-03",
        "last_updated": "2014-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171W00000X",
            "taxonomy_group": "",
            "desc": "Contractor",
            "state": "NV",
            "license": "0506246",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Contractor in Cardiff by the Sea, CA
• Providers in Cardiff by the Sea, CA by specialty
• Contractor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.