Provider Demographics
NPI:1770367930
Name:HAFFENDEN, GWENDOLYN (DPT)
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:
Last Name:HAFFENDEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2561 LAC DE VILLE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-5645
Mailing Address - Country:US
Mailing Address - Phone:585-869-5140
Mailing Address - Fax:585-869-5142
Practice Address - Street 1:91 ERIE CANAL DR STE E
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4603
Practice Address - Country:US
Practice Address - Phone:585-910-2242
Practice Address - Fax:585-869-5142
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050753225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist