Provider Demographics
NPI:1063811768
Name:WIELAND, JENNIFER L (PTA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:WIELAND
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 WEST HIGH STREET
Mailing Address - Street 2:PPG-OH/MIDWEST COMMUNITY HEALTH ASSOCIATES, INC.
Mailing Address - City:BRYAN
Mailing Address - State:OH
Mailing Address - Zip Code:43506
Mailing Address - Country:US
Mailing Address - Phone:419-636-4517
Mailing Address - Fax:419-636-6438
Practice Address - Street 1:442 WEST HIGH STREET
Practice Address - Street 2:PPG-OH/MIDWEST COMMUNITY HEALTH ASSOCIATES, INC.
Practice Address - City:BRYAN
Practice Address - State:OH
Practice Address - Zip Code:43506
Practice Address - Country:US
Practice Address - Phone:419-636-4517
Practice Address - Fax:419-636-6438
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA.08087225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist