Provider Demographics
NPI:1568683068
Name:CARRANCO, WENDY JANE (PT)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:JANE
Last Name:CARRANCO
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 1:1572 DENA CIR
Mailing Address - Street 2:
Mailing Address - City:WAUCHULA
Mailing Address - State:FL
Mailing Address - Zip Code:33873-8410
Mailing Address - Country:US
Mailing Address - Phone:863-781-2108
Mailing Address - Fax:
Practice Address - Street 1:1572 DENA CIR
Practice Address - Street 2:
Practice Address - City:WAUCHULA
Practice Address - State:FL
Practice Address - Zip Code:33873-8410
Practice Address - Country:US
Practice Address - Phone:863-781-2108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT14738225100000X
AL52071225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL52071OtherAL PT LICENSE
FLPT14738OtherPHYSICAL THERAPY LICENSE