Provider Demographics
NPI:1760869887
Name:RATLIFF, WENDY (LMT)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:
Last Name:RATLIFF
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2488 DAVID RAINES RD APT 301
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107-4120
Mailing Address - Country:US
Mailing Address - Phone:318-820-3528
Mailing Address - Fax:
Practice Address - Street 1:2488 DAVID RAINES RD APT 301
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107-4120
Practice Address - Country:US
Practice Address - Phone:318-820-3528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4814225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist