Provider Demographics
NPI:1508638461
Name:SPRADLIN, WENDY (PTA)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:SPRADLIN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9815 MAIN ST STE 206
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:MD
Mailing Address - Zip Code:20872-2099
Mailing Address - Country:US
Mailing Address - Phone:301-253-6761
Mailing Address - Fax:
Practice Address - Street 1:9815 MAIN ST STE 206
Practice Address - Street 2:
Practice Address - City:DAMASCUS
Practice Address - State:MD
Practice Address - Zip Code:20872-2099
Practice Address - Country:US
Practice Address - Phone:301-253-6761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA5765225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant