Wichman, Wyatt Robert

Wichman, Wyatt Robert is an sole proprietor health care provider with primary practice located at 100 W Broadway Ste 750 , Glendale CA 91210-1215. He recently has 2 registered licenses in different health care specialties including Ambulatory Health Care Facilities / Occupational Medicine, Ambulatory Health Care Facilities / Physical Therapy. Ambulatory Health Care Facilities / Physical Therapy is his primary health care specialty. Wichman, Wyatt Robert can be contacted via phone (323) 419-4103.

Contact Information

Primary practice address
100 W Broadway Ste 750 Glendale CA 91210-1215
Phone: (323) 419-4103
Fax: (323) 419-5507
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Occupational Medicine 261QX0100X 03316548 California
Ambulatory Health Care Facilities / Physical Therapy 261QP2000X 03316548 California

Profile Details

NPI number 1265072904
LBN Legal business name Wichman, Wyatt Robert
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 10th, 2020
Last updated Jan 14th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1265072904 NPPES
California Other 03316548 PHYSICAL THERAPY AGENCY

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