Provider Demographics
NPI:1346468113
Name:SMITH, WENDY FULK (LPTA)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:FULK
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14032 LITTLE DRY RIVER RD
Mailing Address - Street 2:
Mailing Address - City:FULKS RUN
Mailing Address - State:VA
Mailing Address - Zip Code:22830-2604
Mailing Address - Country:US
Mailing Address - Phone:540-896-8855
Mailing Address - Fax:
Practice Address - Street 1:LOYALTON OF STAUNTON
Practice Address - Street 2:1900 HILLSMERE LANE
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401
Practice Address - Country:US
Practice Address - Phone:540-851-0210
Practice Address - Fax:540-851-0251
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306001400225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant