Provider Demographics
NPI:1700913092
Name:WENNING, PATRICK BARTHOLOMEW (MPT)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:BARTHOLOMEW
Last Name:WENNING
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 TOLEDO TER
Mailing Address - Street 2:APT 516
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-1397
Mailing Address - Country:US
Mailing Address - Phone:646-712-2064
Mailing Address - Fax:
Practice Address - Street 1:5410 EDSON LN
Practice Address - Street 2:SUITE 350
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3107
Practice Address - Country:US
Practice Address - Phone:301-881-9313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026757-1225100000X
MD19693225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist