Provider Demographics
NPI:1831706555
Name:WIBBENMEYER, NEIL (DPT)
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:
Last Name:WIBBENMEYER
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 FALLS OF NEUSE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3450
Mailing Address - Country:US
Mailing Address - Phone:919-846-9668
Mailing Address - Fax:919-846-9663
Practice Address - Street 1:8300 FALLS OF NEUSE RD STE 104
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3450
Practice Address - Country:US
Practice Address - Phone:919-846-9668
Practice Address - Fax:919-846-9663
Is Sole Proprietor?:No
Enumeration Date:2020-09-27
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
NCP20106225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist