Doctor Name: | MR. BRENT WESLEY WAHLBERG |
NPI Number: | 1225133663 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | RPT |
License Number: | PT396 |
Business Practice Address: | 725 6th St Ste 101 Clarkston, WA - 994032006 |
Business Phone Number: | 5097588510 |
Business Fax Number: | 5097519149 |
Mailing Address: | 725 6th St Ste 101, CLARKSTON |
State: | WA |
Postal Code: | 994032006 |
Phone Number: | 5097588510 |
Fax Number: | 5097519149 |
NPI Enumeration Date: | 09/13/2006 |
NPI Last Update Date: | 02/11/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | PT396 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | ID |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |