Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 21960 | MA |
NPI | 1528732625 |
---|---|
Provider Name | Nicholas Wendel |
First Address | Boston, MA 02215-1394 |
Second Address | Boston, MA 02215-1605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2021 |
Last Update Date | 03/08/2021 |