Provider Demographics
NPI:1639366339
Name:MCDERMOTT, WENDY ROSE (PHYSICAL THERAPY)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:ROSE
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:PHYSICAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 JOHN MAHAR HWY
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-6599
Mailing Address - Country:US
Mailing Address - Phone:413-536-1876
Mailing Address - Fax:
Practice Address - Street 1:501 JOHN MAHAR HWY
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-6599
Practice Address - Country:US
Practice Address - Phone:413-536-1876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3624225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant