MEDICARE: WINIFRED WETHERALL

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	225200000X	Physical Therapy Assistant	A8077	NC

General Provider Information

NPI Number	:	1144904558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WINIFRED WETHERALL

Provider Business Mailing Address
First Line	:	703 N US 29 HWY
Second Line	:
City	:	CHINA GROVE
State	:	NC
Zip	:	28023-2617
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	703 N US 29 HWY
Second Line	:
City	:	CHINA GROVE
State	:	NC
Zip	:	28023-2617
Country	:	US
Telephone Number	:	704-859-5040
Fax Number	:

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

Provider Enumeration Date	:	06/14/2023
Last Update Date	:	06/14/2023

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Directions to “ WINIFRED WETHERALL ” Practice Location

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