Provider Demographics
NPI:1225427776
Name:WENZLAFF, JOSHUA (PT, DPT, ATC)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
Last Name:WENZLAFF
Suffix:
Gender:M
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 W 13 MILE RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-6516
Mailing Address - Country:US
Mailing Address - Phone:248-566-3525
Mailing Address - Fax:
Practice Address - Street 1:4401 W 13 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6516
Practice Address - Country:US
Practice Address - Phone:248-566-3525
Practice Address - Fax:248-566-3527
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501018891225100000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program