Provider Demographics
NPI:1558482422
Name:GROSSMAN, WENDY BETH (PT)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:BETH
Last Name:GROSSMAN
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 1:250 SUMMERWIND LN
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-1868
Mailing Address - Country:US
Mailing Address - Phone:215-513-9881
Mailing Address - Fax:
Practice Address - Street 1:250 SUMMERWIND LN
Practice Address - Street 2:
Practice Address - City:HARLEYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19438-1868
Practice Address - Country:US
Practice Address - Phone:215-513-9881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013390L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018395400005Medicaid