Basic Information
| Provider Information | |||||||||
| NPI: | 1770057200 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | PATIN | ||||||||
| FirstName: | WENDY | ||||||||
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| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 127 W BROAD ST STE 850 | ||||||||
| Address2: | |||||||||
| City: | LAKE CHARLES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 706014394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3373108500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 175 MAGNOLIA TRL | ||||||||
| Address2: | |||||||||
| City: | LUMBERTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 776579276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257724037 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2019 | ||||||||
| LastUpdateDate: | 01/17/2019 | ||||||||
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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 | 225200000X | 2093770 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.