Provider Demographics
NPI:1710007133
Name:BELL, WANDA (PT)
Entity Type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:
Last Name:BELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:WANDA
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5907 W. MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604
Mailing Address - Country:US
Mailing Address - Phone:903-759-6500
Mailing Address - Fax:903-759-6500
Practice Address - Street 1:5907 W. MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604
Practice Address - Country:US
Practice Address - Phone:903-759-6500
Practice Address - Fax:903-759-6500
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1110948174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0631053-03Medicaid
TX063105302Medicaid