Provider Demographics
NPI:1013054600
Name:WIENS, GAYLE A (RPT)
Entity Type:Individual
Prefix:MS
First Name:GAYLE
Middle Name:A
Last Name:WIENS
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 W GLENDALE AVE, SUITE 28
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-8400
Mailing Address - Country:US
Mailing Address - Phone:602-399-2378
Mailing Address - Fax:
Practice Address - Street 1:2830 W GLENDALE AVE STE 28
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-8450
Practice Address - Country:US
Practice Address - Phone:602-399-2378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8208225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist