Provider Demographics
NPI:1245768605
Name:WENDEL, KRISTIAN LYNNE (PT, DPT)
Entity Type:Individual
Prefix:MISS
First Name:KRISTIAN
Middle Name:LYNNE
Last Name:WENDEL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CONNECTICUT ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-1714
Mailing Address - Country:US
Mailing Address - Phone:908-232-7914
Mailing Address - Fax:
Practice Address - Street 1:500 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-1407
Practice Address - Country:US
Practice Address - Phone:973-966-5483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-30
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00335600225200000X
NJ40QA01925800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant