Provider Demographics
NPI:1326261157
Name:TODD, WENDY DENISE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:DENISE
Last Name:TODD
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2534
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-2534
Mailing Address - Country:US
Mailing Address - Phone:907-235-5409
Mailing Address - Fax:
Practice Address - Street 1:34540 ALAMAR ROAD
Practice Address - Street 2:
Practice Address - City:ANCHOR POINT
Practice Address - State:AK
Practice Address - Zip Code:99556
Practice Address - Country:US
Practice Address - Phone:907-235-5409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK0545225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPT0545Medicaid