Provider Demographics
NPI:1104121128
Name:RIEDI, WENDY S (NCTMB)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:S
Last Name:RIEDI
Suffix:
Gender:F
Credentials:NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 GROUSE DR
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:PA
Mailing Address - Zip Code:18014-9125
Mailing Address - Country:US
Mailing Address - Phone:610-413-3675
Mailing Address - Fax:
Practice Address - Street 1:172 GROUSE DR
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:PA
Practice Address - Zip Code:18014-9125
Practice Address - Country:US
Practice Address - Phone:610-413-3675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-23
Last Update Date:2011-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist