Provider Demographics
NPI:1184903262
Name:WEHENKEL, BRANDON JAMES (PT, DPT)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:JAMES
Last Name:WEHENKEL
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 1:1716 P ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NE
Mailing Address - Zip Code:68305-1740
Mailing Address - Country:US
Mailing Address - Phone:402-274-7500
Mailing Address - Fax:
Practice Address - Street 1:1314 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEBRASKA CITY
Practice Address - State:NE
Practice Address - Zip Code:68410-1930
Practice Address - Country:US
Practice Address - Phone:402-873-8918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2993225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist