Provider Demographics
NPI:1457559940
Name:EATON, WENDY MARIE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:MARIE
Last Name:EATON
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MISS
Other - First Name:WENDY
Other - Middle Name:MARIE
Other - Last Name:GUTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:260 BALDWIN DR
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-3084
Mailing Address - Country:US
Mailing Address - Phone:219-851-5270
Mailing Address - Fax:219-851-5270
Practice Address - Street 1:745 BUENA VISTA DR
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3431
Practice Address - Country:US
Practice Address - Phone:219-851-5270
Practice Address - Fax:219-851-5270
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT-1269225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW24389Medicare PIN