Provider Demographics
NPI:1285948315
Name:WENZEL, LISA A (MS, CES)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:A
Last Name:WENZEL
Suffix:
Gender:F
Credentials:MS, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 W BELTLINE HWY
Mailing Address - Street 2:SUITE 207
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-2318
Mailing Address - Country:US
Mailing Address - Phone:608-417-6102
Mailing Address - Fax:608-417-5770
Practice Address - Street 1:2501 W BELTLINE HWY
Practice Address - Street 2:SUITE 207
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-2318
Practice Address - Country:US
Practice Address - Phone:608-417-6102
Practice Address - Fax:608-417-5770
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11001700Medicaid
WI11001700Medicaid