Provider Demographics
NPI:1699749168
Name:MCKENNA, WENDI WADE (DPT, PCS)
Entity type:Individual
Prefix:DR
First Name:WENDI
Middle Name:WADE
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:DPT, PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5611 PALMER WAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92010-7253
Mailing Address - Country:US
Mailing Address - Phone:858-442-1094
Mailing Address - Fax:760-602-8430
Practice Address - Street 1:5611 PALMER WAY
Practice Address - Street 2:SUITE B
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92010-7253
Practice Address - Country:US
Practice Address - Phone:858-442-1094
Practice Address - Fax:760-479-0658
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA254082251P0200X
IL700120802251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics