Provider Demographics
NPI:1447676986
Name:WELLBORN, BRITTANY FICKLING (PTA)
Entity type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:FICKLING
Last Name:WELLBORN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1185 WILSON HALL RD
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-1842
Mailing Address - Country:US
Mailing Address - Phone:803-469-3213
Mailing Address - Fax:803-469-3233
Practice Address - Street 1:1185 WILSON HALL RD
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1842
Practice Address - Country:US
Practice Address - Phone:803-469-3213
Practice Address - Fax:803-469-3233
Is Sole Proprietor?:No
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1454225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant