Provider Demographics
NPI:1821110370
Name:TYLKA, WENDY LEE (PTA)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:LEE
Last Name:TYLKA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 MOUNTAIN RD APT F
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-3160
Mailing Address - Country:US
Mailing Address - Phone:619-971-0233
Mailing Address - Fax:
Practice Address - Street 1:23293 S POINTE DR
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1447
Practice Address - Country:US
Practice Address - Phone:949-770-5843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8007225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant