Provider Demographics
NPI:1841230448
Name:ORTOLANO, WENDY (PT)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:ORTOLANO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6110 COUNTY ROUTE 32
Mailing Address - Street 2:P O BOX 1046
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-1046
Mailing Address - Country:US
Mailing Address - Phone:607-334-5010
Mailing Address - Fax:607-336-7326
Practice Address - Street 1:6110 COUNTY ROUTE 32
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1046
Practice Address - Country:US
Practice Address - Phone:607-334-5010
Practice Address - Fax:607-336-7326
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019913225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP59408Medicare UPIN
NYRA2796Medicare PIN
NYQN8771Medicare PIN
NY650023439Medicare PIN