Provider Demographics
NPI:1538890314
Name:WENTZEL, JOHN DOUGLAS
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DOUGLAS
Last Name:WENTZEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19168 NW 24TH PL
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5366
Mailing Address - Country:US
Mailing Address - Phone:954-684-8016
Mailing Address - Fax:
Practice Address - Street 1:19168 NW 24TH PL
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-5366
Practice Address - Country:US
Practice Address - Phone:954-684-8016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer