MEDICARE: MRS. WENDY REE CONTI PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	04565	OH

General Provider Information

NPI Number	:	1124244231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. WENDY REE CONTI PTA

Provider Business Mailing Address
First Line	:	825 RANCHWOOD DR.
Second Line	:
City	:	TIFFIN
State	:	OH
Zip	:	44883
Country	:	US
Telephone Number	:	419-447-6090
Fax Number	:

Provider Business Practice Location Address
First Line	:	825 TOWNSHIP ROAD 1172
Second Line	:
City	:	TIFFIN
State	:	OH
Zip	:	44883-8807
Country	:	US
Telephone Number	:	419-447-6090
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	07/08/2007

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