Provider Demographics
NPI:1306020003
Name:ACHTERBERG, WENDI ANN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:WENDI
Middle Name:ANN
Last Name:ACHTERBERG
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4939 EDGE O'WOODS DR.
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095
Mailing Address - Country:US
Mailing Address - Phone:262-677-8116
Mailing Address - Fax:262-677-8116
Practice Address - Street 1:4939 EDGE O'WOODS DR.
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095
Practice Address - Country:US
Practice Address - Phone:262-677-8116
Practice Address - Fax:262-677-8116
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI939-019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant