Provider Demographics
NPI:1861571242
Name:WENGSTROM, GERLINDA IRENE (LPTA)
Entity type:Individual
Prefix:MRS
First Name:GERLINDA
Middle Name:IRENE
Last Name:WENGSTROM
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36040 JASON DR
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:OH
Mailing Address - Zip Code:44044-9302
Mailing Address - Country:US
Mailing Address - Phone:440-522-3203
Mailing Address - Fax:
Practice Address - Street 1:5700 LOMBARDO CTR
Practice Address - Street 2:STE 205
Practice Address - City:SEVEN HILLS
Practice Address - State:OH
Practice Address - Zip Code:44131-2540
Practice Address - Country:US
Practice Address - Phone:216-447-1149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA01231225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant