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Individual

MRS. STACEY WENCK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PTA

Contact information

Practice address
9200 FRANKLIN SQUARE DR, BALTIMORE, MD 21237-4458
(443) 391-2600
Mailing address
738 ALDWORTH RD, DUNDALK, MD 21222-1304
(443) 503-5307

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A3549
MD

Other

Enumeration date
11/30/2010
Last updated
11/30/2010
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