Provider Demographics
NPI:1497021687
Name:MILANES, WENDY (PTA)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:
Last Name:MILANES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8945 NW 164TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33018-6190
Mailing Address - Country:US
Mailing Address - Phone:786-390-0797
Mailing Address - Fax:
Practice Address - Street 1:5729 NW 151ST ST
Practice Address - Street 2:SUITE #102
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2481
Practice Address - Country:US
Practice Address - Phone:786-390-0797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-01
Last Update Date:2012-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 19273225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant