Provider Demographics
NPI:1053543199
Name:WETHERBEE, PATRICIA MARIE (PT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MARIE
Last Name:WETHERBEE
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 1:129 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON SPRINGS
Mailing Address - State:ME
Mailing Address - Zip Code:04981-4136
Mailing Address - Country:US
Mailing Address - Phone:207-323-2198
Mailing Address - Fax:
Practice Address - Street 1:129 CHURCH ST
Practice Address - Street 2:
Practice Address - City:STOCKTON SPRINGS
Practice Address - State:ME
Practice Address - Zip Code:04981-4136
Practice Address - Country:US
Practice Address - Phone:207-323-2198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT2280225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME219180000Medicare PIN