Provider Demographics
NPI:1528561586
Name:WENDLING, JESI (LMT)
Entity Type:Individual
Prefix:
First Name:JESI
Middle Name:
Last Name:WENDLING
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 CALUMET ST
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-3432
Mailing Address - Country:US
Mailing Address - Phone:716-713-1943
Mailing Address - Fax:
Practice Address - Street 1:218 CALUMET ST
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-3432
Practice Address - Country:US
Practice Address - Phone:716-713-1943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029734225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist