Individual
MICHAEL S WANBAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
4070 PLAZA DR STE 107, CASPER, WY 82604-4296
(307) 472-8871
(307) 235-6262
Mailing address
4140 CENTENNIAL HILLS BLVD STE B, CASPER, WY 82609-3265
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-506
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
120359200
—
WY
01
—
313189
BCBS
WY
01
—
P00208956
RR MEDICARE
—
Enumeration date
08/12/2005
Last updated
11/13/2023
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