MEDICARE: MR. TIMOTHY J WENDLING MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	26342	CA

General Provider Information

NPI Number	:	1720262942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIMOTHY J WENDLING MPT

Provider Business Mailing Address
First Line	:	1106 WALNUT ST
Second Line	:	SUITE 110
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-2416
Country	:	US
Telephone Number	:	805-788-0805
Fax Number	:	805-788-0845

Provider Business Practice Location Address
First Line	:	1510 W BRANCH ST
Second Line	:
City	:	ARROYO GRANDE
State	:	CA
Zip	:	93420-1817
Country	:	US
Telephone Number	:	805-489-7912
Fax Number	:	805-489-9697

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/24/2007
Last Update Date	:	07/11/2013

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