Provider Demographics
NPI:1659653988
Name:WENDY BRESETT PHYSICAL THERAPY, P.L.L.C.
Entity Type:Organization
Organization Name:WENDY BRESETT PHYSICAL THERAPY, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BRESETT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:518-585-2172
Mailing Address - Street 1:84 MONTCALM ST STE 5
Mailing Address - Street 2:
Mailing Address - City:TICONDEROGA
Mailing Address - State:NY
Mailing Address - Zip Code:12883-1361
Mailing Address - Country:US
Mailing Address - Phone:518-321-7118
Mailing Address - Fax:
Practice Address - Street 1:84 MONTCALM ST STE 5
Practice Address - Street 2:
Practice Address - City:TICONDEROGA
Practice Address - State:NY
Practice Address - Zip Code:12883-1361
Practice Address - Country:US
Practice Address - Phone:518-321-7118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014005-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty