Provider Demographics
NPI:1104294255
Name:WENZINGER, PHILIP CARL
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:CARL
Last Name:WENZINGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 WESTERVILLE WOODS DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-7354
Mailing Address - Country:US
Mailing Address - Phone:614-373-9355
Mailing Address - Fax:
Practice Address - Street 1:3421 WESTERVILLE WOODS DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-7354
Practice Address - Country:US
Practice Address - Phone:614-373-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-07
Last Update Date:2015-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program