Provider Demographics
NPI:1033166939
Name:RICHARDS, WENDY A (MS PT, DPT)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:A
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MS PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1047
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:ME
Mailing Address - Zip Code:04039-1047
Mailing Address - Country:US
Mailing Address - Phone:207-657-5600
Mailing Address - Fax:207-657-5620
Practice Address - Street 1:94 AUBURN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2141
Practice Address - Country:US
Practice Address - Phone:207-797-7578
Practice Address - Fax:207-797-8165
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1761225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist