Provider Demographics
NPI:1457944787
Name:WENDLAND, KRISTEN ELIZABETH GREEN (PT, DPT, ATC, CWT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ELIZABETH GREEN
Last Name:WENDLAND
Suffix:
Gender:F
Credentials:PT, DPT, ATC, CWT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:ELIZABETH
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, ATC
Mailing Address - Street 1:238 OLD FORGE RD
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:CT
Mailing Address - Zip Code:06065-1216
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22 BRAMHALL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3175
Practice Address - Country:US
Practice Address - Phone:207-662-6079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT4333225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist