Provider Demographics
NPI:1184620767
Name:WILBURN, MICHAEL W (MPT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:W
Last Name:WILBURN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 NEFF AVE
Mailing Address - Street 2:STE C
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-3495
Mailing Address - Country:US
Mailing Address - Phone:540-434-1200
Mailing Address - Fax:540-434-1203
Practice Address - Street 1:313 NEFF AVE
Practice Address - Street 2:STE C
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3495
Practice Address - Country:US
Practice Address - Phone:540-434-1200
Practice Address - Fax:540-434-1203
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203746225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
269060OtherANTHEM
269060OtherANTHEM