Provider Demographics
NPI:1063494011
Name:POPPY, WENDELINE K (PT, LAT, ATC)
Entity Type:Individual
Prefix:MS
First Name:WENDELINE
Middle Name:K
Last Name:POPPY
Suffix:
Gender:F
Credentials:PT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4949 N WHITE RIVER DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-9074
Mailing Address - Country:US
Mailing Address - Phone:812-855-8429
Mailing Address - Fax:812-855-1810
Practice Address - Street 1:1001 E 17TH ST
Practice Address - Street 2:ASSEMBLY HALL
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47408-1590
Practice Address - Country:US
Practice Address - Phone:812-855-8429
Practice Address - Fax:812-855-1810
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05001963A225100000X
IN36000136A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer