Healthcare Provider Details

I. General information

NPI: 1700605581
Provider Name (Legal Business Name): MEGAN ELIZABETH WENTE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 N MAPLE ST
EFFINGHAM IL
62401-1779
US

IV. Provider business mailing address

18556 N 1300TH ST
EFFINGHAM IL
62401-6861
US

V. Phone/Fax

Practice location:
  • Phone: 217-347-1243
  • Fax: 217-347-1558
Mailing address:
  • Phone: 217-821-4525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.026498
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: