Provider Demographics
NPI:1972027431
Name:WENDT, ROBERT BERNARD (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BERNARD
Last Name:WENDT
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1584 NORTHWOOD DR APT 4
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-8304
Mailing Address - Country:US
Mailing Address - Phone:715-928-2397
Mailing Address - Fax:
Practice Address - Street 1:904 WHITE AVE
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-3932
Practice Address - Country:US
Practice Address - Phone:208-882-1426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-26
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-52672251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty