Provider Demographics
NPI:1134336969
Name:PENNIMAN, WENDY BETH (PTA)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:BETH
Last Name:PENNIMAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 DEERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-2379
Mailing Address - Country:US
Mailing Address - Phone:508-697-4281
Mailing Address - Fax:
Practice Address - Street 1:165 DEERFIELD DR
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-2379
Practice Address - Country:US
Practice Address - Phone:508-697-4281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3965225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant