Provider Demographics
NPI:1164830386
Name:WESTFALL, WENDY (MT)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:WESTFALL
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-3506
Mailing Address - Country:US
Mailing Address - Phone:719-275-0028
Mailing Address - Fax:
Practice Address - Street 1:1216 MAIN ST
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-3506
Practice Address - Country:US
Practice Address - Phone:719-275-0028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2676172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist