Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | 1215 | TX |
NPI | 1366675761 |
---|---|
Provider Name | Liberty B Wethington |
First Address | Fort Worth, TX 76104-4250 |
Second Address | Fort Worth, TX 76104-4250 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2009 |
Last Update Date | 10/05/2012 |