Individual
MR. WYATT ROBERT WICHMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
100 W BROADWAY STE 750, GLENDALE, CA 91210-1215
(323) 419-4103
(323) 419-5507
Mailing address
100 W BROADWAY STE 750, GLENDALE, CA 91210-1215
(323) 419-4103
(323) 419-5507
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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