Provider Demographics
NPI:1316195209
Name:WIENK, BRIAN (PT, SCD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:WIENK
Suffix:
Gender:M
Credentials:PT, SCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8813
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:630-590-4329
Practice Address - Street 1:3320 S SYCAMORE AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57110-4532
Practice Address - Country:US
Practice Address - Phone:605-231-5590
Practice Address - Fax:605-231-5589
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD06392251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
9296204OtherDAKOTACARE
1316195209OtherWELLMARK BCBS/TRICARE
1316195209OtherMN BCBS
9296204OtherDAKOTACARE