Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 17109 | MA |
NPI | 1003028259 |
---|---|
Provider Name | Ms. Wendy Elizabeth Beres |
First Address | Randolph, MA 02368-4820 |
Second Address | Weymouth, MA 02188-1110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 14/10/2008 |