Provider Demographics
NPI:1902660483
Name:BAKAL, WENDY JO (LMT, NBHWC)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:JO
Last Name:BAKAL
Suffix:
Gender:F
Credentials:LMT, NBHWC
Other - Prefix:MS
Other - First Name:JO
Other - Middle Name:
Other - Last Name:BAKAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT, NBHWC
Mailing Address - Street 1:9617 N OKLAWAHA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-4529
Mailing Address - Country:US
Mailing Address - Phone:917-439-1623
Mailing Address - Fax:
Practice Address - Street 1:9617 N OKLAWAHA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-4529
Practice Address - Country:US
Practice Address - Phone:917-439-1623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLA-3253495171400000X
FLMA95252225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171400000XOther Service ProvidersHealth & Wellness Coach