Provider Demographics
NPI:1477741064
Name:KLEMS, WENDY MARIE
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:MARIE
Last Name:KLEMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7540 N 19TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-7967
Mailing Address - Country:US
Mailing Address - Phone:888-873-4221
Mailing Address - Fax:888-543-2289
Practice Address - Street 1:1100 1ST ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NE
Practice Address - Zip Code:68405-9708
Practice Address - Country:US
Practice Address - Phone:402-761-2261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2171225100000X
OHPT 007581225100000X
NJQA 00778300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist