Provider Demographics
NPI:1891213948
Name:CANARY, WENDY SUSAN (PT)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:SUSAN
Last Name:CANARY
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 1:132 HUGHES LN
Mailing Address - Street 2:
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069-5927
Mailing Address - Country:US
Mailing Address - Phone:908-757-7927
Mailing Address - Fax:
Practice Address - Street 1:132 HUGHES LN
Practice Address - Street 2:
Practice Address - City:WATCHUNG
Practice Address - State:NJ
Practice Address - Zip Code:07069-5927
Practice Address - Country:US
Practice Address - Phone:908-757-7927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-08
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00453300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist