Provider Demographics
NPI:1245773969
Name:HERMANSON, WENDY (LMT, CLT, CA, OMT)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:HERMANSON
Suffix:
Gender:F
Credentials:LMT, CLT, CA, OMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3565 UTICA RIDGE RD STE B
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1654
Mailing Address - Country:US
Mailing Address - Phone:563-332-6036
Mailing Address - Fax:
Practice Address - Street 1:3565 UTICA RIDGE RD STE B
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1654
Practice Address - Country:US
Practice Address - Phone:563-332-6036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA006889172M00000X
IL227.015890172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist