Provider Demographics
NPI:1194916544
Name:FJELDHEIM, WENDY CORRINE (PTA)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:CORRINE
Last Name:FJELDHEIM
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 1:28 LILLIAN LN
Mailing Address - Street 2:
Mailing Address - City:DONIPHAN
Mailing Address - State:NE
Mailing Address - Zip Code:68832-9776
Mailing Address - Country:US
Mailing Address - Phone:402-845-2000
Mailing Address - Fax:
Practice Address - Street 1:28 LILLIAN LN
Practice Address - Street 2:
Practice Address - City:DONIPHAN
Practice Address - State:NE
Practice Address - Zip Code:68832-9776
Practice Address - Country:US
Practice Address - Phone:402-845-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE441225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant