Provider Demographics
NPI:1114138567
Name:HETHERINGTON, KARIN KAY (PT)
Entity type:Individual
Prefix:
First Name:KARIN
Middle Name:KAY
Last Name:HETHERINGTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KARIN
Other - Middle Name:K
Other - Last Name:CARLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 5105
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-5100
Mailing Address - Country:US
Mailing Address - Phone:828-258-8800
Mailing Address - Fax:
Practice Address - Street 1:89 HOSPITAL DR STE A
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-4838
Practice Address - Country:US
Practice Address - Phone:828-258-8800
Practice Address - Fax:828-258-0416
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT003583225100000X
NCP22984225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP22984OtherPT LICENSE