Provider Demographics
NPI:1194727222
Name:WURZBACH, ANN-MARIE (PT)
Entity type:Individual
Prefix:MISS
First Name:ANN-MARIE
Middle Name:
Last Name:WURZBACH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1985 CHAMBERS LN
Mailing Address - Street 2:
Mailing Address - City:HOLTVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92250-9533
Mailing Address - Country:US
Mailing Address - Phone:760-356-1150
Mailing Address - Fax:
Practice Address - Street 1:428 N IMPERIAL AVE
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-2329
Practice Address - Country:US
Practice Address - Phone:760-353-3422
Practice Address - Fax:760-353-9163
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 13114225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT131140OtherBLUE SHIELD
CAWPT13114AMedicare ID - Type Unspecified
CAW16944Medicare ID - Type Unspecified