MEDICARE: JULIETTA RUTH WENZEL P.T.

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	PT11347	FL

General Provider Information

NPI Number	:	1912956087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIETTA RUTH WENZEL P.T.

Provider Business Mailing Address
First Line	:	4001 N OCEAN DR
Second Line	:	SUITE 302
City	:	LAUDERDALE BY THE SEA
State	:	FL
Zip	:	33308-5968
Country	:	US
Telephone Number	:	954-351-2299
Fax Number	:	954-351-3399

Provider Business Practice Location Address
First Line	:	4001 N OCEAN DR
Second Line	:	SUITE 302
City	:	LAUDERDALE BY THE SEA
State	:	FL
Zip	:	33308-5928
Country	:	US
Telephone Number	:	954-351-2299
Fax Number	:	954-351-3399

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

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	04/11/2014

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