Provider Demographics
NPI:1972725653
Name:THOMAS L WENHOLD PHYSICAL THERAPIST PC
Entity Type:Organization
Organization Name:THOMAS L WENHOLD PHYSICAL THERAPIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WENHOLD
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:585-765-2562
Mailing Address - Street 1:POB 481
Mailing Address - Street 2:25 LAKE AVENUE
Mailing Address - City:LYNDONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14098-0481
Mailing Address - Country:US
Mailing Address - Phone:585-765-2562
Mailing Address - Fax:585-765-2198
Practice Address - Street 1:POB 481
Practice Address - Street 2:25 LAKE AVENUE
Practice Address - City:LYNDONVILLE
Practice Address - State:NY
Practice Address - Zip Code:14098-0481
Practice Address - Country:US
Practice Address - Phone:585-765-2562
Practice Address - Fax:585-765-2198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006954-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1202Medicare ID - Type UnspecifiedGROUP PT PRACTICE