Provider Demographics
NPI:1336356708
Name:WIECHEC, MICHAEL (MPT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:WIECHEC
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 1:121 N JONES RD
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-9167
Mailing Address - Country:US
Mailing Address - Phone:248-202-0846
Mailing Address - Fax:
Practice Address - Street 1:16259 SYLVESTER RD SW
Practice Address - Street 2:SUITE 102
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3049
Practice Address - Country:US
Practice Address - Phone:248-202-0846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010436225100000X
TX1171678225100000X
MI5501011573225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist