Provider Demographics
NPI:1598126385
Name:HARDESTY, WENDY
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:HARDESTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7801 YORK RD
Mailing Address - Street 2:SUITE 224
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7446
Mailing Address - Country:US
Mailing Address - Phone:443-991-5907
Mailing Address - Fax:443-548-0904
Practice Address - Street 1:11431 CRONHILL DR
Practice Address - Street 2:SUITE C
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-2269
Practice Address - Country:US
Practice Address - Phone:410-363-8550
Practice Address - Fax:443-548-0904
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA4409225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant