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General NPI Number Information
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NPI Number | 1174026389
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Entity Type | Individual
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Provider Name | ANTONETTE WIBEL PT
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Gender | Female
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Dates
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Enumeration Date | 03/14/2018
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Last Update Date | 03/14/2018
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Provider Practice Location Address
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Address Line | 7800 W OUTER DR
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City | DETROIT
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State | MI
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Zip | 48235-3461
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Country | US
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Telephone | 313-543-6295
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Fax |
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Provider Business Mailing Address
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Address Line | 4143 IVERNESS LN
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48323-2826
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Country | US
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Telephone | 248-961-2188
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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