Provider Demographics
NPI:1770626822
Name:WETHERELL, CYNTHIA ANN (AT,C)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:ANN
Last Name:WETHERELL
Suffix:
Gender:F
Credentials:AT,C
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:ANN
Other - Last Name:WETHERELL-CARTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AT,C
Mailing Address - Street 1:15 LOUISIANA PKWY
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-2143
Mailing Address - Country:US
Mailing Address - Phone:732-961-3881
Mailing Address - Fax:
Practice Address - Street 1:281 ELTON ADELPHIA RD
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-9211
Practice Address - Country:US
Practice Address - Phone:732-431-8460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000278002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer