Basic Information
| Provider Information | |||||||||
| NPI: | 1952549214 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ORTH | ||||||||
| FirstName: | WENDY | ||||||||
| MiddleName: | L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4776 HODGES BLVD | ||||||||
| Address2: | STE 101 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322247218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042232363 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1409 KINGSLEY AVE | ||||||||
| Address2: | SUITE 3-A | ||||||||
| City: | ORANGE PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320734537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043485511 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2009 | ||||||||
| LastUpdateDate: | 09/19/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 15592 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | 225700000X | MA38316 | FL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.