Provider Demographics
NPI:1285659821
Name:NELSON, WENDY C (PT)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:C
Last Name:NELSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:2846 MOODY PKWY
Practice Address - Street 2:STE 200
Practice Address - City:MOODY
Practice Address - State:AL
Practice Address - Zip Code:35004-3328
Practice Address - Country:US
Practice Address - Phone:205-640-4881
Practice Address - Fax:205-640-4882
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH2400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL9386254OtherPRIVATE HEALTHCARE SYSTEM
AL51092798OtherBLUE CROSS BLUE SHIELD
AL000092798Medicare ID - Type UnspecifiedCMS
AL631156852001OtherTRICARE
AL6410104OtherUNITED HEALTHCARE
ALCH4209Medicare ID - Type UnspecifiedRAILROAD