Provider Demographics
NPI:1861493371
Name:WONDOLOWSKI, ROBERT JOHN (PTA)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JOHN
Last Name:WONDOLOWSKI
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:163 ALBEE RD
Mailing Address - Street 2:
Mailing Address - City:UXBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01569-1981
Mailing Address - Country:US
Mailing Address - Phone:508-278-0320
Mailing Address - Fax:
Practice Address - Street 1:214 N MAIN ST
Practice Address - Street 2:SUITE 107
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-1131
Practice Address - Country:US
Practice Address - Phone:508-650-1856
Practice Address - Fax:508-653-9563
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7571225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant