Individual
MACK KENNETH WINGREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7407 WILLOW RD, FREDERICK, MD 21702-2500
(301) 644-5600
Mailing address
6617 HIGH BEACH CT E, NEW MARKET, MD 21774-6852
(410) 530-3361
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A4884
MD
Other
Enumeration date
05/07/2021
Last updated
05/07/2021
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