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General NPI Number Information
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NPI Number | 1366385643
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Entity Type | Individual
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Provider Name | MARK WIMBERLEY DPT
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Gender | Male
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Dates
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Enumeration Date | 04/13/2026
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Last Update Date | 04/13/2026
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Provider Practice Location Address
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Address Line | 2005 MIZELL AVE # 2400
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City | WINTER PARK
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State | FL
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Zip | 32792-4126
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Country | US
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Telephone | 407-646-7703
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Fax |
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Provider Business Mailing Address
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Address Line | 2005 LAKE BALDWIN LN UNIT 202
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City | ORLANDO
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State | FL
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Zip | 32814-6931
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Country | US
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Telephone | 954-734-4240
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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 | PT40225
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License Number State | FL
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