Provider Demographics
NPI:1972049617
Name:WEHNER, ERIC ZACHARY (MED, ATC)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:ZACHARY
Last Name:WEHNER
Suffix:
Gender:M
Credentials:MED, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8452 M-119 HARBOR PLAZA
Mailing Address - Street 2:
Mailing Address - City:HARBOR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49740-9595
Mailing Address - Country:US
Mailing Address - Phone:231-348-7002
Mailing Address - Fax:231-348-7009
Practice Address - Street 1:8452 M 119
Practice Address - Street 2:
Practice Address - City:HARBOR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49740-9595
Practice Address - Country:US
Practice Address - Phone:231-348-7002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010010612255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer