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General NPI Number Information
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NPI Number | 1467548362
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Entity Type | Individual
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Provider Name | MICHAEL GLENN WIGHT P.T.
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Gender | Male
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4440 CALLE REAL
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City | SANTA BARBARA
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State | CA
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Zip | 93110-1002
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Country | US
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Telephone | 805-683-1491
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Fax | 805-964-6181
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Provider Business Mailing Address
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Address Line | 306 BARRANCA AVE APT 2
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City | SANTA BARBARA
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State | CA
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Zip | 93109-2222
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Country | US
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Telephone | 805-965-2230
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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 | PT8768
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License Number State | CA
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