Provider Demographics
NPI:1861283756
Name:WENCL, LINDSEY (PT, DPT)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:WENCL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:
Other - Last Name:CLEMENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:25934 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-5299
Mailing Address - Country:US
Mailing Address - Phone:757-469-7586
Mailing Address - Fax:
Practice Address - Street 1:53-59 PUBLIC SQ STE 202
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-2674
Practice Address - Country:US
Practice Address - Phone:315-786-3225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053257225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist