Provider Demographics
NPI:1154842086
Name:WENIG, GREGOR MARTIN (DPT)
Entity Type:Individual
Prefix:
First Name:GREGOR
Middle Name:MARTIN
Last Name:WENIG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 PLEASANT CT
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:54923-2236
Mailing Address - Country:US
Mailing Address - Phone:920-290-1901
Mailing Address - Fax:
Practice Address - Street 1:220 24TH ST S
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-1908
Practice Address - Country:US
Practice Address - Phone:715-424-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13914-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist