Provider Demographics
NPI:1558486787
Name:SMITH, WENDY (CMT)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 D ST
Mailing Address - Street 2:SUITE #3
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-2607
Mailing Address - Country:US
Mailing Address - Phone:707-763-6327
Mailing Address - Fax:
Practice Address - Street 1:405 D ST
Practice Address - Street 2:SUITE #3
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2607
Practice Address - Country:US
Practice Address - Phone:707-763-6327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist