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General NPI Number Information
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NPI Number | 1689726176
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Entity Type | Individual
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Provider Name | CHARLES V WABBERSEN P.T.
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Gender | Male
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 11/16/2007
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Provider Practice Location Address
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Address Line | 2851 MATLOCK RD #442
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City | MANSFIELD
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State | TX
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Zip | 76063-5037
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Country | US
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Telephone | 817-473-6246
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Fax | 817-473-2014
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Provider Business Mailing Address
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Address Line | 2851 MATLOCK RD #442
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City | MANSFIELD
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State | TX
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Zip | 76063-5037
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Country | US
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Telephone | 817-473-6246
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Fax | 817-473-2014
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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 | 1157230
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number |
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License Number State | TX
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