Provider Demographics
NPI:1760507735
Name:WARNER, WENDY ELAINE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:ELAINE
Last Name:WARNER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 W MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:MA
Mailing Address - Zip Code:01225-9633
Mailing Address - Country:US
Mailing Address - Phone:413-743-4733
Mailing Address - Fax:
Practice Address - Street 1:231 W MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:MA
Practice Address - Zip Code:01225-9633
Practice Address - Country:US
Practice Address - Phone:413-743-4733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3857225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant