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NPI Code Detail

MEDICARE: MR. JD WENDEBORN PT

MEDICARE: MR. JD WENDEBORN 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
1225100000XPhysical Therapist1000099TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11000099OTHERTXTEXAS BOARD OF PT EXAMINE

General Provider Information

NPI Number : 1699870840
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JD WENDEBORN PT
Provider Business Mailing Address
First Line : 1220 N MALINCHE AVE
Second Line :
City : LAREDO
State : TX
Zip : 78043-3354
Country : US
Telephone Number : 956-722-2431
Fax Number : 956-722-7553
Provider Business Practice Location Address
First Line : 1220 N MALINCHE AVE
Second Line :
City : LAREDO
State : TX
Zip : 78043-3354
Country : US
Telephone Number : 956-722-2431
Fax Number : 956-722-7553
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2006
Last Update Date : 02/19/2008

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