Healthcare Provider Details

I. General information

NPI: 1275059271
Provider Name (Legal Business Name): BARRY WIMBISH PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2017
Last Update Date: 08/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 PINEBROOK RD
VENICE FL
34285-6421
US

IV. Provider business mailing address

112 LA PALMA CT
VENICE FL
34292-7402
US

V. Phone/Fax

Practice location:
  • Phone: 941-488-6733
  • Fax:
Mailing address:
  • Phone: 941-539-3706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT19216
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: