Provider Demographics
NPI:1427717792
Name:WENDELL, CAITLIN LEASURE (PT)
Entity type:Individual
Prefix:DR
First Name:CAITLIN
Middle Name:LEASURE
Last Name:WENDELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:RUTH
Other - Last Name:LEASURE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11204 RACETRACK RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-3370
Mailing Address - Country:US
Mailing Address - Phone:410-208-1525
Mailing Address - Fax:
Practice Address - Street 1:11204 RACETRACK RD STE 101
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-3370
Practice Address - Country:US
Practice Address - Phone:410-208-1525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23727225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist