=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972027431
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT BERNARD WENDT PT, DPT, SCS, CSCS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2017
-----------------------------------------------------
Last Update Date | 08/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2817 ROCK MERRITT AVE WOMACK ARMY MEDICAL CENTER STOP A
-----------------------------------------------------
City | FORT BRAGG
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28310-5000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-907-8922
-----------------------------------------------------
Fax | 910-907-6069
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2817 ROCK MERRITT AVE WOMACK ARMY MEDICAL CENTER STOP A
-----------------------------------------------------
City | FORT BRAGG
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28310-5000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-907-8922
-----------------------------------------------------
Fax | 910-907-6069
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251S0007X
-----------------------------------------------------
Taxonomy Name | Sports Physical Therapist
-----------------------------------------------------
License Number | 14690-24
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------