Provider Demographics
NPI:1700033636
Name:TABANCURA, WENNIE MAE ORMIDO (RPT)
Entity Type:Individual
Prefix:MS
First Name:WENNIE MAE
Middle Name:ORMIDO
Last Name:TABANCURA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:WENNIE MAE
Other - Middle Name:BENITO
Other - Last Name:ORMIDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1304 SAWGRASS POINTE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-4873
Mailing Address - Country:US
Mailing Address - Phone:314-791-7928
Mailing Address - Fax:
Practice Address - Street 1:1304 SAWGRASS POINTE DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32824-4873
Practice Address - Country:US
Practice Address - Phone:314-791-7928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010278225100000X
MO2006002061225100000X
FLPT25149225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist