Provider Demographics
NPI:1598948259
Name:BRESETT, WENDY LYNN (PT)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:LYNN
Last Name:BRESETT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:84 MONTCALM ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:TICONDEROGA
Mailing Address - State:NY
Mailing Address - Zip Code:12883-1361
Mailing Address - Country:US
Mailing Address - Phone:518-585-6003
Mailing Address - Fax:518-585-6063
Practice Address - Street 1:84 MONTCALM ST
Practice Address - Street 2:SUITE 5
Practice Address - City:TICONDEROGA
Practice Address - State:NY
Practice Address - Zip Code:12883-1361
Practice Address - Country:US
Practice Address - Phone:518-585-6003
Practice Address - Fax:518-585-6063
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014005-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist