Provider Demographics
NPI:1427236983
Name:MA, WENDY (PT)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:MA
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 1:800 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-3526
Mailing Address - Country:US
Mailing Address - Phone:415-387-3769
Mailing Address - Fax:
Practice Address - Street 1:1740 MARCO POLO WAY
Practice Address - Street 2:SUITE 3
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-4522
Practice Address - Country:US
Practice Address - Phone:650-552-9355
Practice Address - Fax:650-652-1951
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT34351225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist