BEREVON TAYSHAWN WYATT (NPI# 1114526068) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114526068 |
| Entity Type | Individual |
| Full Name | BEREVON TAYSHAWN WYATT |
| Practice Address |
3510 N Oakland Ave Ste 206 Milwaukee WI 53211-2746 |
| Mailing Address |
1727 W Keefe Ave Milwaukee WI 53206-2322 |
| Practice Telephone | 4149154213 |
| Mailing Telephone | 4149154213 |
| Enumeration Date | 2020-10-21 |
| Last Update Date | 2020-10-21 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 225700000X | Massage Therapist | 14485-146 | WI | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
3510 N OAKLAND AVE STE 206 |
| City | MILWAUKEE |
| State | WI |
| Zip Code | 53211-2746 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821602335 | Gabriella Caitrin Emanuele | Occupational Therapist | Harborchase of Shorewood, 1111 E Capitol Drive, Shorewood, WI 53211 | 2020-09-02 |
| 1710527783 | Sage Specialty Pharmacy Inc. | Pharmacy | 4001 N. Oakland Ave, Shorewood, WI 53211 | 2020-01-08 |
| 1861043952 | Rosina Bloomingdale Norton | Nurse Practitioner | 1921 E Harford Ave, Milwaukee, WI 53211 | 2019-09-20 |
| 1528556255 | Renee Reckelberg | Specialist/Technologist | 3409 North Downer Avenue, Pavilion, Suite 350, Milwaukee, WI 53211 | 2018-04-27 |
| 1700325602 | Wisconsin Vision, Inc. | Optometrist | 4163 N Oakland Ave, Shorewood, WI 53211 | 2017-02-13 |
| 1750827556 | Daniel Butz M.d., S.c. | Plastic Surgery | 2350 N Lake Dr Ste 304, Milwaukee, WI 53211 | 2017-01-17 |
| 1528517232 | Therese Simonis | Speech-Language Pathologist | 2390 N Lake Drive, Milwaukee, WI 53211 | 2016-09-23 |
| 1982075701 | Katie Michel | Specialist/Technologist | 3409 N. Downer Ave, Milwaukee, WI 53211 | 2015-10-20 |
| 1255776365 | Sarah Elizabeth Brill | Social Worker | 4433 N Oakland Ave Ste D, Shorewood, WI 53211 | 2013-05-02 |
| 1679814537 | Nicole Anne Parulski | Physical Therapist | 2301 North Lake Dr, Milwaukee, WI 53211 | 2013-03-01 |
| Find all providers in zip 53211 | ||||
| Taxonomy Code | 225700000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Massage Therapist |
| An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003439134 | Roberto Lorenzana | Massage Therapist | 515 W Lincoln Ave, Milwaukee, WI 53207-1133 | 2020-05-23 |
| 1568016426 | Scott M Feist | Massage Therapist | 945 N 12th St Fl 4, Milwaukee, WI 53233-1305 | 2019-07-30 |
| 1992261408 | Amy Lynn Porath | Massage Therapist | 2970 S Delaware Ave, Milwaukee, WI 53207-2562 | 2019-02-20 |
| 1780173740 | Deondre Lewis | Massage Therapist | 4028 S Howell Ave, Milwaukee, WI 53207-4408 | 2018-05-05 |
| 1164807889 | Myia Mitchell | Massage Therapist | 6012 W. North Avenue, Milwaukee, WI 53213 | 2015-07-23 |
| 1497161095 | Melissa Young | Massage Therapist | 4359 S Howell Ave, Suite 203, Milwaukee, WI 53207-5056 | 2014-07-03 |
| 1780027128 | Aquillas Lashonda Scott | Massage Therapist | 1916 W Melvina St, Milwaukee, WI 53206-2464 | 2013-04-16 |
| 1740523968 | Jeanne Goggins Zautner | Massage Therapist | 3457 S Burrell St, Milwaukee, WI 53207-3345 | 2013-04-06 |
| 1720316730 | Paula Maria Ortega Flores | Massage Therapist | 2121 South Kinnickinnic Ave, Suite 3, Milwaukee, WI 53207 | 2009-12-02 |
| 1114533478 | Rebecca Ann Biskup | Massage Therapist | 1020 N 12th St, Milwaukee, WI 53233-1308 | 2020-09-21 |
| Find all providers in MILWAUKEE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.