Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 694-019 | WI |
NPI | 1245445766 |
---|---|
Provider Name | Mrs. Cynthia May Wendt |
First Address | Redgranite, WI 54970-9732 |
Second Address | Weyauwega, WI 54983 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 08/07/2007 |