Healthcare Provider Details

I. General information

NPI: 1285988972
Provider Name (Legal Business Name): LUCIE WUENSTEL DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LUCIE HORN

II. Dates (important events)

Enumeration Date: 11/01/2012
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15620 MCGREGOR BLVD STE 115
FORT MYERS FL
33908-2528
US

IV. Provider business mailing address

25241 ELEMENTARY WAY STE 200
BONITA SPRINGS FL
34135-7883
US

V. Phone/Fax

Practice location:
  • Phone: 239-454-6262
  • Fax: 239-454-0350
Mailing address:
  • Phone: 239-947-4184
  • Fax: 239-947-4171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT35830
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: