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General NPI Number Information
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NPI Number | 1609232826
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Entity Type | Individual
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Provider Name | EMILY WANERKA DPT, PT
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Gender | Female
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Dates
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Enumeration Date | 01/04/2016
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Last Update Date | 04/20/2017
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Provider Practice Location Address
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Address Line | 7 SUTHERLAND RD APT 302
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City | BRIGHTON
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State | MA
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Zip | 02135-7031
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Country | US
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Telephone | 518-538-2596
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Fax |
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Provider Business Mailing Address
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Address Line | 654 BEACON ST STE 2
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City | BOSTON
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State | MA
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Zip | 02215-2099
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Country | US
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Telephone | 518-538-2596
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 22097
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License Number State | MA
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