Provider Demographics
NPI:1346063252
Name:WENGER, MALARRY R
Entity type:Individual
Prefix:
First Name:MALARRY
Middle Name:R
Last Name:WENGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MALARRY
Other - Middle Name:
Other - Last Name:ERSKINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:170 MCCARTHY LN
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48609-5032
Mailing Address - Country:US
Mailing Address - Phone:989-239-9748
Mailing Address - Fax:
Practice Address - Street 1:3901 BAY RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2438
Practice Address - Country:US
Practice Address - Phone:989-401-5282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501303572225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist