Provider Demographics
NPI:1902490881
Name:VIVIERS, WENDY KIM (PT DPT MPHIL)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:KIM
Last Name:VIVIERS
Suffix:
Gender:F
Credentials:PT DPT MPHIL
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:KIM
Other - Last Name:BOUCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:124 CABERNET DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-8773
Mailing Address - Country:US
Mailing Address - Phone:781-558-0016
Mailing Address - Fax:
Practice Address - Street 1:1999 S NC HIGHWAY 119
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-9738
Practice Address - Country:US
Practice Address - Phone:919-568-0083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP19646225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist