Provider Demographics
NPI:1376743765
Name:KNUTSEN, WENDY A (RPT)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:A
Last Name:KNUTSEN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 COUNTRYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5408
Mailing Address - Country:US
Mailing Address - Phone:760-942-2546
Mailing Address - Fax:
Practice Address - Street 1:431 COUNTRYWOOD LN
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5408
Practice Address - Country:US
Practice Address - Phone:760-942-2546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10777225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist