Provider Demographics
NPI:1194926451
Name:WUSTENEY, EILEEN THERESA (PT)
Entity type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:THERESA
Last Name:WUSTENEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MILLER AVE
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-6027
Mailing Address - Country:US
Mailing Address - Phone:781-849-3794
Mailing Address - Fax:
Practice Address - Street 1:95 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-4301
Practice Address - Country:US
Practice Address - Phone:781-848-3678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3068225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist