Provider Demographics
NPI:1972941789
Name:MAYHEW, WANDA LEA (PT)
Entity Type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:LEA
Last Name:MAYHEW
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:WANDA
Other - Middle Name:LEA
Other - Last Name:BEATTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:154 HINDMAN RD
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-2417
Mailing Address - Country:US
Mailing Address - Phone:724-282-6806
Mailing Address - Fax:724-282-7138
Practice Address - Street 1:154 HINDMAN RD
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-2417
Practice Address - Country:US
Practice Address - Phone:724-282-6806
Practice Address - Fax:724-282-7138
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT002687L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist