Provider Demographics
NPI:1063798726
Name:WENTZEL, DENISE A (PT)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:A
Last Name:WENTZEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 NE 166TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684
Mailing Address - Country:US
Mailing Address - Phone:541-292-4244
Mailing Address - Fax:360-836-5715
Practice Address - Street 1:1623 NE 107TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-4344
Practice Address - Country:US
Practice Address - Phone:360-356-6811
Practice Address - Fax:855-840-8203
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR06202225100000X
WA60013093225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1992192231Medicaid