Provider Demographics
NPI:1710301072
Name:LEVANWAY, WENDY MARIE (MS, ATC, PES)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:MARIE
Last Name:LEVANWAY
Suffix:
Gender:F
Credentials:MS, ATC, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11355 MOUNTAIN VIEW DR
Mailing Address - Street 2:APT 12
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-7221
Mailing Address - Country:US
Mailing Address - Phone:949-278-9684
Mailing Address - Fax:
Practice Address - Street 1:11355 MOUNTAIN VIEW DR
Practice Address - Street 2:APT 12
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-7221
Practice Address - Country:US
Practice Address - Phone:949-278-9684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer