Healthcare Provider Details

I. General information

NPI: 1457262719
Provider Name (Legal Business Name): VIRGINIA ANNE WIGHT DPT,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 CAMINO DEL RIO S STE 103
SAN DIEGO CA
92108-3520
US

IV. Provider business mailing address

35503 CRABAPPLE ST
MURRIETA CA
92562-4594
US

V. Phone/Fax

Practice location:
  • Phone: 619-501-2195
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number311061
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: