IndividualActive
Berevon Wyatt
NPI 1114526068 · Massage Therapist · Milwaukee, WI
Provider details
- NPI number
- 1114526068
- Entity type
- Individual
- Primary specialty
- Massage TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Sex
- Male
- Sole proprietor
- Yes
- License
- 14485-146 (WI)
Specialties & taxonomies
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Practice location
3510 N Oakland Ave Ste 206
Milwaukee, WI 53211-2746
Phone: (414) 915-4213
Approximate (ZIP-level) locationGet directions
Mailing address
1727 W Keefe Ave
Milwaukee, WI 53206-2322
Registry dates
- Enumerated
- 2020-10-21
- Last updated
- 2020-10-21
- Certified
- 2020-10-21
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.