Provider Demographics
NPI:1932294915
Name:STIMSON, WENDY MARIAN (PT)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:MARIAN
Last Name:STIMSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1191 BRUCKNER CIRCLE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINVIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040
Mailing Address - Country:US
Mailing Address - Phone:650-793-5079
Mailing Address - Fax:
Practice Address - Street 1:1000 FREMONT AVE STE 195
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-6055
Practice Address - Country:US
Practice Address - Phone:650-947-0257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2019-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT9520208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
00PT95200Medicare UPIN