Provider Demographics
NPI:1689233603
Name:WENNBERG, NANCY MONICA (DPT)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:MONICA
Last Name:WENNBERG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6628 SEPULVEDA BLVD APT 306
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-1212
Mailing Address - Country:US
Mailing Address - Phone:917-480-6771
Mailing Address - Fax:
Practice Address - Street 1:12723 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2430
Practice Address - Country:US
Practice Address - Phone:818-579-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist