Provider Demographics
NPI:1912956087
Name:WENZEL, JULIETTA RUTH (PT)
Entity Type:Individual
Prefix:
First Name:JULIETTA
Middle Name:RUTH
Last Name:WENZEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 N OCEAN DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:LAUDERDALE BY THE SEA
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5968
Mailing Address - Country:US
Mailing Address - Phone:954-351-2299
Mailing Address - Fax:954-351-3399
Practice Address - Street 1:4001 N OCEAN DR
Practice Address - Street 2:SUITE 302
Practice Address - City:LAUDERDALE BY THE SEA
Practice Address - State:FL
Practice Address - Zip Code:33308-5928
Practice Address - Country:US
Practice Address - Phone:954-351-2299
Practice Address - Fax:954-351-3399
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT11347225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAD667ZMedicare PIN