Basic Information
| Provider Information | |||||||||
| NPI: | 1205366218 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WENKER | ||||||||
| FirstName: | STACEY | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 HIGHLAND AVENUE | ||||||||
| Address2: | MAIL STOP 2424 | ||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537922424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082638061 | ||||||||
| FaxNumber: | 6082627679 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 HIGHLAND AVENUE | ||||||||
| Address2: | MAIL STOP 2424 | ||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537922424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082638061 | ||||||||
| FaxNumber: | 6082627679 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 13774-24 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.