Provider Demographics
NPI:1366943854
Name:WENDELL, DEANNA (PTA)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:WENDELL
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 1:91670 DETRITCH RD
Mailing Address - Street 2:
Mailing Address - City:BOWERSTON
Mailing Address - State:OH
Mailing Address - Zip Code:44695-9729
Mailing Address - Country:US
Mailing Address - Phone:740-945-1157
Mailing Address - Fax:
Practice Address - Street 1:339 E MAPLE ST
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-2593
Practice Address - Country:US
Practice Address - Phone:330-498-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA005146225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant