Provider Demographics
NPI:1669813788
Name:VENARD, WYNNE (PT)
Entity Type:Individual
Prefix:
First Name:WYNNE
Middle Name:
Last Name:VENARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:WYNNE
Other - Middle Name:
Other - Last Name:RODMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:7300 WASHINGTON AVE
Mailing Address - Street 2:STE B
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-6525
Mailing Address - Country:US
Mailing Address - Phone:262-321-6000
Mailing Address - Fax:
Practice Address - Street 1:7300 WASHINGTON AVE
Practice Address - Street 2:STE B
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-6525
Practice Address - Country:US
Practice Address - Phone:262-321-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12193225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist