Individual
BRIDGET O WIBORG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
5777 E MAYO BLVD, PHOENIX, AZ 85054-4502
(480) 301-8000
Mailing address
5777 E MAYO BLVD, PHOENIX, AZ 85054-4502
(480) 301-8000
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6985
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86080015085259B088
TRIWEST
AZ
05
—
987381
—
AZ
01
—
P00624770
RAILROAD MEDICARE
AZ
Enumeration date
11/29/2005
Last updated
03/25/2013
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