Basic Information
| Provider Information | |||||||||
| NPI: | 1285988972 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WUENSTEL | ||||||||
| FirstName: | LUCIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | DPT | ||||||||
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| OtherLastName: | HORN | ||||||||
| OtherFirstName: | LUCIE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 25241 ELEMENTARY WAY STE 200 | ||||||||
| Address2: | |||||||||
| City: | BONITA SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341357883 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2399474184 | ||||||||
| FaxNumber: | 2399474171 | ||||||||
| Practice Location | |||||||||
| Address1: | 15620 MCGREGOR BLVD STE 115 | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339082528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2394546262 | ||||||||
| FaxNumber: | 2394540350 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2012 | ||||||||
| LastUpdateDate: | 09/20/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT35830 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.