Provider Demographics
NPI:1023367661
Name:WENTZ, CHAD ALAN (ATC)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:ALAN
Last Name:WENTZ
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 HIGHLAND AVE
Mailing Address - Street 2:C/O JEN RODER
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-8963
Mailing Address - Country:US
Mailing Address - Phone:610-393-9371
Mailing Address - Fax:
Practice Address - Street 1:2030 HIGHLAND AVE
Practice Address - Street 2:C/O JEN RODER
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-8963
Practice Address - Country:US
Practice Address - Phone:610-393-9371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0034912255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer