Individual
MR. WYATT ROBERT WICHMAN
Active
Individual
MR. WYATT ROBERT WICHMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
03316548
CA
261QX0100X
Occupational Medicine Clinic/Center
03316548
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03316548
PHYSICAL THERAPY AGENCY
CA
Enumeration date
01/10/2020
Last updated
01/14/2020
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