Provider Demographics
NPI:1558927137
Name:VALLERSCHAMP, WENDY (PT)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:VALLERSCHAMP
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2022 STARGAZERS RD
Mailing Address - Street 2:
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320-4844
Mailing Address - Country:US
Mailing Address - Phone:484-364-6967
Mailing Address - Fax:
Practice Address - Street 1:17470 BROOKSIDE TRACE CT
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-6201
Practice Address - Country:US
Practice Address - Phone:813-443-5042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-19
Last Update Date:2019-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT34465225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist