Provider Demographics
NPI:1205389830
Name:WUNDER, MADELINE (PT)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:WUNDER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-3561
Mailing Address - Country:US
Mailing Address - Phone:508-477-4800
Mailing Address - Fax:
Practice Address - Street 1:168 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-3561
Practice Address - Country:US
Practice Address - Phone:508-477-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-01
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22394225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist