Provider Demographics
NPI:1295955094
Name:BOOKER, WENDY JEAN (PT)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:JEAN
Last Name:BOOKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 N KS HWY 2
Mailing Address - Street 2:
Mailing Address - City:ANTHONY
Mailing Address - State:KS
Mailing Address - Zip Code:67003-2526
Mailing Address - Country:US
Mailing Address - Phone:620-914-1200
Mailing Address - Fax:
Practice Address - Street 1:108 E ROSS ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:KS
Practice Address - Zip Code:67026-7821
Practice Address - Country:US
Practice Address - Phone:620-584-3777
Practice Address - Fax:620-584-6777
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02803225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA2801Medicare PIN