Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | DAPT002380 | PA |
Y | 225100000X | Physical Therapist | PT019442 | PA |
NPI | 1003072117 |
---|---|
Provider Name | Cheryl Elizabeth Wenger |
First Address | Middleburg, PA 17842-8910 |
Second Address | Millersburg, PA 17061-1501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2008 |
Last Update Date | 30/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1025163040003 | (05) | PA |
811778 | MEDICARE (01) | PA |