Provider Demographics
NPI:1063626356
Name:WETHERINGTON, PAULA BROWN (LPTA)
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:BROWN
Last Name:WETHERINGTON
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 MEADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:TRENT WOODS
Mailing Address - State:NC
Mailing Address - Zip Code:28562-7419
Mailing Address - Country:US
Mailing Address - Phone:252-638-6192
Mailing Address - Fax:
Practice Address - Street 1:919 HEARTHSIDE CT
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-7225
Practice Address - Country:US
Practice Address - Phone:252-633-6673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2177225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant