Provider Demographics
NPI:1548630528
Name:LOVELAND, WENDY (PT)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:LOVELAND
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:PUTNAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:10503 N DORAL DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILLS
Mailing Address - State:UT
Mailing Address - Zip Code:84062-8690
Mailing Address - Country:US
Mailing Address - Phone:801-763-7776
Mailing Address - Fax:
Practice Address - Street 1:10503 N DORAL DR
Practice Address - Street 2:
Practice Address - City:CEDAR HILLS
Practice Address - State:UT
Practice Address - Zip Code:84062-8690
Practice Address - Country:US
Practice Address - Phone:801-763-7776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-02
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7189269-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist