Provider Demographics
NPI:1669112637
Name:ALLEN, WENDOLYNN LACHELLE (PTA)
Entity type:Individual
Prefix:
First Name:WENDOLYNN
Middle Name:LACHELLE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18665 MIDWAY RD APT 1511
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-3939
Mailing Address - Country:US
Mailing Address - Phone:504-432-7527
Mailing Address - Fax:
Practice Address - Street 1:101 WATERMERE DR
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-8116
Practice Address - Country:US
Practice Address - Phone:817-466-3094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-29
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2174412225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant