Provider Demographics
NPI:1093923955
Name:WESTLUND, GWENDOLYN KAY (PT)
Entity Type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:KAY
Last Name:WESTLUND
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 125
Mailing Address - Street 2:
Mailing Address - City:WEYERHAEUSER
Mailing Address - State:WI
Mailing Address - Zip Code:54895-0125
Mailing Address - Country:US
Mailing Address - Phone:715-353-2982
Mailing Address - Fax:
Practice Address - Street 1:725 W PARK AVE
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-3276
Practice Address - Country:US
Practice Address - Phone:715-720-2160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3351-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40138500Medicaid