Provider Demographics
NPI:1780413849
Name:WENZEL, ANTHONY (DPT)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:WENZEL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 PAGNOTTA DR
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-4454
Mailing Address - Country:US
Mailing Address - Phone:631-747-2470
Mailing Address - Fax:
Practice Address - Street 1:1312 MIDDLE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-2514
Practice Address - Country:US
Practice Address - Phone:631-732-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist