Provider Demographics
NPI:1225673346
Name:DELLOW, WENDY LEIGH
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:LEIGH
Last Name:DELLOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROCTON
Mailing Address - State:NY
Mailing Address - Zip Code:14716-9749
Mailing Address - Country:US
Mailing Address - Phone:716-672-4371
Mailing Address - Fax:
Practice Address - Street 1:138 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BROCTON
Practice Address - State:NY
Practice Address - Zip Code:14716-9749
Practice Address - Country:US
Practice Address - Phone:716-672-4371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019565-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist