Healthcare Provider Details

I. General information

NPI: 1003332024
Provider Name (Legal Business Name): WENDY MARONGE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 08/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7054 VETERANS PKWY
PELL CITY AL
35125-5117
US

IV. Provider business mailing address

4109 HIGHWAY 98 W
SUMMIT MS
39666-9132
US

V. Phone/Fax

Practice location:
  • Phone: 205-227-7985
  • Fax:
Mailing address:
  • Phone: 601-276-3909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number3528
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: