Provider Demographics
NPI:1922578715
Name:HARRELL, WENDY (PT, MPT, DPT)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:HARRELL
Suffix:
Gender:F
Credentials:PT, MPT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16202 AVESTON PL
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3812
Mailing Address - Country:US
Mailing Address - Phone:240-620-8619
Mailing Address - Fax:
Practice Address - Street 1:2300 BELLEVIEW AVE
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-3004
Practice Address - Country:US
Practice Address - Phone:240-620-8619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD203732251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics