MEDICARE: CAROLINE WEATHERFORD

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	2025021566	MO

General Provider Information

NPI Number	:	1194610139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE WEATHERFORD

Provider Business Mailing Address
First Line	:	406 MYERS ST
Second Line	:
City	:	SHELBINA
State	:	MO
Zip	:	63468-1423
Country	:	US
Telephone Number	:	660-415-7366
Fax Number	:

Provider Business Practice Location Address
First Line	:	5722 CLARION ST
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30040-0306
Country	:	US
Telephone Number	:	470-252-7889
Fax Number	:

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

Provider Enumeration Date	:	06/10/2025
Last Update Date	:	06/10/2025

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Directions to “ CAROLINE WEATHERFORD ” Practice Location

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