Provider Demographics
NPI:1629961107
Name:KULLBERG, WENDY (DPT)
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:
Last Name:KULLBERG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 SE DOUGLAS ST UNIT 254
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-3198
Mailing Address - Country:US
Mailing Address - Phone:913-485-0353
Mailing Address - Fax:
Practice Address - Street 1:20101 E JACKSON DR STE D
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-1956
Practice Address - Country:US
Practice Address - Phone:813-485-0353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO111556225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist