Provider Demographics
NPI:1013042381
Name:WENDT, JUDY LEE (LMP LICENSED MASSAGE)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:LEE
Last Name:WENDT
Suffix:
Gender:F
Credentials:LMP LICENSED MASSAGE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 NE KAMIAKEN ST
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-2611
Mailing Address - Country:US
Mailing Address - Phone:509-332-0555
Mailing Address - Fax:509-334-9522
Practice Address - Street 1:167 NE KAMIAKEN ST
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-2611
Practice Address - Country:US
Practice Address - Phone:509-332-0555
Practice Address - Fax:509-334-9522
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00009262225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist