Basic Information
| Provider Information | |||||||||
| NPI: | 1891915534 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEESMITH | ||||||||
| FirstName: | WENDY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | PHYSICAL THERAPIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1353 HARDEN CHAPEL RD | ||||||||
| Address2: | |||||||||
| City: | LYONS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 304364948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9125268249 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1703 MEADOWS LN | ||||||||
| Address2: | |||||||||
| City: | VIDALIA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 304748915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9125378921 | ||||||||
| FaxNumber: | 9125385341 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 003713 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.