MEDICARE: WENDY WECKSTEIN PT

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	225100000X	Physical Therapist	5501002820	MI

General Provider Information

NPI Number	:	1215313739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY WECKSTEIN PT

Provider Business Mailing Address
First Line	:	PO BOX 674779
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48267-4779
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 MUNSON AVE
Second Line	:	STE 103 & 104
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-3059
Country	:	US
Telephone Number	:	231-486-6330
Fax Number	:

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

Provider Enumeration Date	:	08/06/2015
Last Update Date	:	08/06/2015

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