Active NPI
Michael Jerome Wenclawiak, PT
- Physical Therapist
- Austell, GA
National Provider Identifier
1821360355
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT003445
- Practice address
- 3999 Austell Rd.
Suite 701
Austell, GA 30106 - Phone
- (770) 739-0090
- NPI assigned
- Jan 30, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT003445 | GA | Primary |
Addresses
Primary practice location
3999 Austell Rd.
Suite 701
Austell, GA 30106
Mailing address
6067 Gentlewind CT
Powder Springs, GA 30127-6316
Phone (678) 838-5194
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT003445 | GA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1327881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1327881600000",
"number": "1821360355",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6067 GENTLEWIND CT",
"city": "POWDER SPRINGS",
"state": "GA",
"postal_code": "301276316",
"telephone_number": "678-838-5194"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3999 AUSTELL RD.",
"address_2": "SUITE 701",
"city": "AUSTELL",
"state": "GA",
"postal_code": "30106",
"telephone_number": "770-739-0090"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WENCLAWIAK",
"first_name": "MICHAEL",
"middle_name": "JEROME",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-01-30",
"last_updated": "2012-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "GA",
"license": "PT003445",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austell, GA
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- Wellstaris Medical Equipment & Supply Corp
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- Wellstreet of Georgia PC
- Wellstreet of Georgia PC
- West Atlanta Endodontics
- West Cobb Modern Endodontics
- West Cobb Urology, PC
- West Georgia Infectious Diseases
- Brandon D West, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.