Provider Demographics
NPI:1528247319
Name:SOULEK, WENDY L (PT)
Entity type:Individual
Prefix:MS
First Name:WENDY
Middle Name:L
Last Name:SOULEK
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 1:1720 N SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:OGALLALA
Mailing Address - State:NE
Mailing Address - Zip Code:69153-3307
Mailing Address - Country:US
Mailing Address - Phone:308-284-4068
Mailing Address - Fax:308-284-8381
Practice Address - Street 1:1720 N SPRUCE ST
Practice Address - Street 2:
Practice Address - City:OGALLALA
Practice Address - State:NE
Practice Address - Zip Code:69153-3307
Practice Address - Country:US
Practice Address - Phone:308-284-4068
Practice Address - Fax:308-284-8381
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE919225100000X
SD0449225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist