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General NPI Number Information
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NPI Number | 1336356708
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Entity Type | Individual
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Provider Name | MICHAEL WIECHEC MPT
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Gender | Male
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 16259 SYLVESTER RD SW SUITE 102
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City | BURIEN
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State | WA
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Zip | 98166-3049
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Country | US
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Telephone | 248-202-0846
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Fax |
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Provider Business Mailing Address
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Address Line | 121 N JONES RD
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City | BAY CITY
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State | MI
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Zip | 48708-9167
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Country | US
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Telephone | 248-202-0846
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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 | PT00010436
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1171678
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501011573
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License Number State | MI
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