Provider Demographics
NPI:1467401125
Name:POTRATZ, WENDY JEAN (ATC)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:JEAN
Last Name:POTRATZ
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31365 WILD WING DR
Mailing Address - Street 2:
Mailing Address - City:CASS LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56633-3181
Mailing Address - Country:US
Mailing Address - Phone:218-335-0053
Mailing Address - Fax:
Practice Address - Street 1:31365 WILD WING DR
Practice Address - Street 2:
Practice Address - City:CASS LAKE
Practice Address - State:MN
Practice Address - Zip Code:56633-3181
Practice Address - Country:US
Practice Address - Phone:218-335-0053
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13442255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer