Provider Demographics
NPI:1396789962
Name:WILBUR, WILLIAM (MSPT, OCS)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:WILBUR
Suffix:
Gender:M
Credentials:MSPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2623 FOREST AVE STE 130
Mailing Address - Street 2:STE 100 & STE 120
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-4392
Mailing Address - Country:US
Mailing Address - Phone:530-876-1006
Mailing Address - Fax:530-876-8225
Practice Address - Street 1:7224 SKYWAY
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-3280
Practice Address - Country:US
Practice Address - Phone:530-876-1006
Practice Address - Fax:530-876-8225
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28202225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT28202OtherPHYSICAL THERAPY LICENSE
CA0PT282021Medicare PIN