MEDICARE: PATRICIA MARIE WETHERBEE PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT2280	ME

General Provider Information

NPI Number	:	1053543199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA MARIE WETHERBEE PT

Provider Business Mailing Address
First Line	:	129 CHURCH ST
Second Line	:
City	:	STOCKTON SPRINGS
State	:	ME
Zip	:	04981-4136
Country	:	US
Telephone Number	:	207-323-2198
Fax Number	:

Provider Business Practice Location Address
First Line	:	129 CHURCH ST
Second Line	:
City	:	STOCKTON SPRINGS
State	:	ME
Zip	:	04981-4136
Country	:	US
Telephone Number	:	207-323-2198
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2009
Last Update Date	:	08/21/2009

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