Individual
MR. BRENT WESLEY WAHLBERG JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPT
Contact information
Practice address
725 6TH ST STE 101, CLARKSTON, WA 99403-2006
(509) 758-8510
(509) 751-9149
Mailing address
725 6TH ST STE 101, CLARKSTON, WA 99403-2006
(509) 758-8510
(509) 751-9149
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT00005041
WA
225100000X
Physical Therapist
PT396
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010007644
BLUE SHIELD
—
01
—
131422
L AND I
WA
05
—
7018757
—
WA
Enumeration date
09/13/2006
Last updated
02/11/2008
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