Alicen Lee Wendall, PTA, BSPTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

30179 Issued in FL

Practice address

400 Celebration PL
Kissimmee, FL 34747-4970

Phone

(407) 303-4000

NPI assigned

Dec 20, 2021

Last updated

Dec 23, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1639958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640217600000",
    "number": "1457011470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1014 E JACKSON ST",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328013040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 CELEBRATION PL",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347474970",
            "telephone_number": "407-303-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WENDALL",
        "first_name": "ALICEN",
        "middle_name": "LEE",
        "name_prefix": "Miss",
        "credential": "PTA, BSPTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-20",
        "last_updated": "2021-12-23",
        "certification_date": "2021-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "30179",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ayres M Wesby, LPN
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• Physical Therapy Assistant in Kissimmee, FL
• Providers in Kissimmee, FL by specialty
• Physical Therapy Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.