Provider Demographics
NPI:1578138863
Name:GREEN, WENDY (PT, DPT)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:GREEN
Suffix:
Gender:
Credentials:PT, DPT
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:ZASTOUPIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6937 CATAMARAN DR
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-3219
Mailing Address - Country:US
Mailing Address - Phone:858-229-5233
Mailing Address - Fax:
Practice Address - Street 1:200 SAXONY RD
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2720
Practice Address - Country:US
Practice Address - Phone:858-381-0614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT300216225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist