Healthcare Provider Details

I. General information

NPI: 1033166939
Provider Name (Legal Business Name): WENDY A RICHARDS MS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 10/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 AUBURN ST SUITE 3
PORTLAND ME
04103-2141
US

IV. Provider business mailing address

PO BOX 1047
GRAY ME
04039-1047
US

V. Phone/Fax

Practice location:
  • Phone: 207-797-7578
  • Fax: 207-797-8165
Mailing address:
  • Phone: 207-657-5600
  • Fax: 207-657-5620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT1761
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: