Healthcare Provider Details

I. General information

NPI: 1063798726
Provider Name (Legal Business Name): DENISE A WENTZEL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2011
Last Update Date: 04/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1623 NE 107TH AVE
VANCOUVER WA
98664-4344
US

IV. Provider business mailing address

1202 NE 166TH AVE
VANCOUVER WA
98684
US

V. Phone/Fax

Practice location:
  • Phone: 360-356-6811
  • Fax: 855-840-8203
Mailing address:
  • Phone: 541-292-4244
  • Fax: 360-836-5715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number06202
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number60013093
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: