Healthcare Provider Details

I. General information

NPI: 1245445766
Provider Name (Legal Business Name): CYNTHIA MAY WENDT PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 E. ALFRED ST. WEYAUWAGA, 717 E. ALFRED
WEYAUWEGA WI
54983
US

IV. Provider business mailing address

536 N 2ND AVE
REDGRANITE WI
54970-9732
US

V. Phone/Fax

Practice location:
  • Phone: 920-867-3121
  • Fax: 920-867-3997
Mailing address:
  • Phone: 920-566-4687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number694-019
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: