Provider Demographics
NPI:1750699096
Name:NORMAN, WENDY RAE (MPT)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:RAE
Last Name:NORMAN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 STATE ROUTE 11
Mailing Address - Street 2:P.O. BOX 285
Mailing Address - City:MOIRA
Mailing Address - State:NY
Mailing Address - Zip Code:12957-2106
Mailing Address - Country:US
Mailing Address - Phone:518-529-4048
Mailing Address - Fax:
Practice Address - Street 1:183 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-2226
Practice Address - Country:US
Practice Address - Phone:518-483-7802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0268752251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics