Provider Demographics
NPI:1730740614
Name:PARHAM, WYYETTA (RRT)
Entity type:Individual
Prefix:
First Name:WYYETTA
Middle Name:
Last Name:PARHAM
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 SOMERSET DR APT L101
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33311-9343
Mailing Address - Country:US
Mailing Address - Phone:754-302-6570
Mailing Address - Fax:954-678-6036
Practice Address - Street 1:2850 SOMERSET DR APT L101
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33311-9343
Practice Address - Country:US
Practice Address - Phone:754-302-6570
Practice Address - Fax:954-678-6036
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-22
Last Update Date:2019-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRT15749227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered