Provider Demographics
NPI:1417173196
Name:PERLMUTTER, WENDY ALICE (PT)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:ALICE
Last Name:PERLMUTTER
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 1:3508 N SUGAN RD
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:PA
Mailing Address - Zip Code:18938-9671
Mailing Address - Country:US
Mailing Address - Phone:215-297-0624
Mailing Address - Fax:
Practice Address - Street 1:3508 N SUGAN RD
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:PA
Practice Address - Zip Code:18938-9671
Practice Address - Country:US
Practice Address - Phone:215-297-0624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012525L2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101123975 0002OtherMA PROMISE NUMBER