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NPI Code Detail

MEDICARE: MICHAEL S WANBAUGH MPT

MEDICARE: MICHAEL S WANBAUGH MPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT-506WY

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00208956OTHERRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3313189OTHERWYBCBS

General Provider Information

NPI Number : 1508868100
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL S WANBAUGH MPT
Provider Business Mailing Address
First Line : 4140 CENTENNIAL HILLS BLVD STE B
Second Line :
City : CASPER
State : WY
Zip : 82609-3265
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4070 PLAZA DR STE 107
Second Line :
City : CASPER
State : WY
Zip : 82604-4296
Country : US
Telephone Number : 307-472-8871
Fax Number : 307-235-6262
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2005
Last Update Date : 11/13/2023

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Directions to “ MICHAEL S WANBAUGH MPT” Practice Location

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