Provider Demographics
NPI:1437126604
Name:HUELSMAN, WENDY G (MSPT)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:G
Last Name:HUELSMAN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26201 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-7822
Mailing Address - Country:US
Mailing Address - Phone:239-498-0558
Mailing Address - Fax:239-498-0557
Practice Address - Street 1:26201 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-7822
Practice Address - Country:US
Practice Address - Phone:239-498-0558
Practice Address - Fax:239-498-0557
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21744225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU4213ZMedicare ID - Type UnspecifiedTIED TO GROUP NUMBE K1923