Provider Demographics
NPI:1154524361
Name:WENGER, PAMELA ANN (PT)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:ANN
Last Name:WENGER
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 1:332 WEBSTER STREET
Mailing Address - Street 2:
Mailing Address - City:CLAY CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:67432
Mailing Address - Country:US
Mailing Address - Phone:785-632-2654
Mailing Address - Fax:
Practice Address - Street 1:509 GROVE STREET
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:KS
Practice Address - Zip Code:67487
Practice Address - Country:US
Practice Address - Phone:785-461-5417
Practice Address - Fax:785-461-5667
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-00601225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist