Provider Demographics
NPI:1730257163
Name:BARTH-LINDBLOM, WANDA B (PT)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:B
Last Name:BARTH-LINDBLOM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 N COFCO CENTER CT
Mailing Address - Street 2:260
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-6462
Mailing Address - Country:US
Mailing Address - Phone:602-279-6905
Mailing Address - Fax:888-445-4263
Practice Address - Street 1:5757 W THUNDERBIRD RD
Practice Address - Street 2:SUITE 465
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4641
Practice Address - Country:US
Practice Address - Phone:602-843-9945
Practice Address - Fax:888-445-4263
Is Sole Proprietor?:No
Enumeration Date:2006-12-02
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ38542251H1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ163910Medicaid
AZ163910Medicaid
AZ1396819546Medicare NSC
AZ113188Medicare PIN
AZZ113264Medicare PIN
AZ1871652131Medicare NSC
AZ1508071119Medicare NSC
AZ1831211143Medicare NSC