Provider Demographics
NPI:1720102841
Name:BINGHAM, WENDY LEE (MPT)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:LEE
Last Name:BINGHAM
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5257 MAJESTIC PEAK DR
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84065-6699
Mailing Address - Country:US
Mailing Address - Phone:801-560-9625
Mailing Address - Fax:
Practice Address - Street 1:3845 W. 4700 S.
Practice Address - Street 2:IHC TAYLORSVILLE HEALTH CENTER
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84118
Practice Address - Country:US
Practice Address - Phone:801-840-2191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5810447-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist