Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics |
NPI | 1235697152 |
---|---|
Provider Name | Angela Weddle |
First Address | Somerset, KY 42501-1707 |
Second Address | Brodhead, KY 40409-8893 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2019 |
Last Update Date | 10/03/2019 |