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General NPI Number Information
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NPI Number | 1700937950
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Entity Type | Individual
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Provider Name | MICHAEL R WIMBERLY II PT,MPT
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Gender | Male
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Dates
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Enumeration Date | 01/15/2007
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Last Update Date | 10/08/2025
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Provider Practice Location Address
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Address Line | 107 FRONT ST STE 230
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City | VIDALIA
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State | LA
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Zip | 71373-2836
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Country | US
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Telephone | 318-336-2224
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Fax | 318-336-6068
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Provider Business Mailing Address
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Address Line | 901 LINDBERG AVE
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City | NATCHEZ
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State | MS
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Zip | 39120-4884
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Country | US
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Telephone | 601-304-4161
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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 | PT04879
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License Number State | LA
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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 | PT3657
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License Number State | MS
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