Provider Demographics
NPI:1215938667
Name:URSO, WENDY (PT)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:
Last Name:URSO
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 1:2035 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33322-3936
Mailing Address - Country:US
Mailing Address - Phone:954-478-4648
Mailing Address - Fax:954-530-5694
Practice Address - Street 1:2035 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33322-3936
Practice Address - Country:US
Practice Address - Phone:954-478-4648
Practice Address - Fax:954-530-5694
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 13607225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY6259AMedicare ID - Type Unspecified
FLY6259ZMedicare PIN