Provider Demographics
NPI:1306853536
Name:COLLINS, WENDY RICHARDSON (PT)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:RICHARDSON
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:WENDY
Other - Middle Name:S
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:3004 16TH ST
Mailing Address - Street 2:SUITE # 303
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-3434
Mailing Address - Country:US
Mailing Address - Phone:415-626-3099
Mailing Address - Fax:
Practice Address - Street 1:3004 16TH ST
Practice Address - Street 2:SUITE # 303
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-3434
Practice Address - Country:US
Practice Address - Phone:415-626-3099
Practice Address - Fax:415-626-1800
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10657225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT106570Medicare ID - Type UnspecifiedPHYSICAL THERAPY MEDICARE