Provider Demographics
NPI:1346204302
Name:MCCANN, WENDY MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:MARIE
Last Name:MCCANN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 TILTON RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1265
Mailing Address - Country:US
Mailing Address - Phone:609-645-0505
Mailing Address - Fax:609-641-3532
Practice Address - Street 1:801 TILTON RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1265
Practice Address - Country:US
Practice Address - Phone:609-645-0505
Practice Address - Fax:609-641-3532
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2020-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04218700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist