Provider Demographics
NPI:1780982652
Name:RETZER, WENDY DIANE (MPT)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:DIANE
Last Name:RETZER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3845 NAUTICAL DR
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-3377
Mailing Address - Country:US
Mailing Address - Phone:760-730-3752
Mailing Address - Fax:866-852-8640
Practice Address - Street 1:533 2ND ST
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3558
Practice Address - Country:US
Practice Address - Phone:800-931-5769
Practice Address - Fax:888-773-3272
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19288225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist