Provider Demographics
NPI:1093948499
Name:WENTZ, GEORGE W (CPO)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:W
Last Name:WENTZ
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 S 77 SUNSHINESTRIP STE C
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8356
Mailing Address - Country:US
Mailing Address - Phone:956-428-1160
Mailing Address - Fax:
Practice Address - Street 1:2325 S 77 SUNSHINESTRIP STE C
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8356
Practice Address - Country:US
Practice Address - Phone:956-428-1160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist