Provider Demographics
NPI:1548348477
Name:GONZALEZ, WENDY G (PT)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:G
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1568
Mailing Address - Street 2:101 NORTH PLAINS INDUSTRIAL ROAD SUTIE 100
Mailing Address - City:WALLINGFOD
Mailing Address - State:CT
Mailing Address - Zip Code:06492
Mailing Address - Country:US
Mailing Address - Phone:203-265-0018
Mailing Address - Fax:203-265-4368
Practice Address - Street 1:101 NORTH PLAINS INDUSTRIAL ROAD
Practice Address - Street 2:SUTIE 100
Practice Address - City:WALLINGFOD
Practice Address - State:CT
Practice Address - Zip Code:06492
Practice Address - Country:US
Practice Address - Phone:203-265-0018
Practice Address - Fax:203-265-4368
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004772225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist