Provider Demographics
NPI:1871925289
Name:WETHERALD, RICHARD NEIL (PT)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:NEIL
Last Name:WETHERALD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3400 CALLOWAY DR STE 603
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-2514
Mailing Address - Country:US
Mailing Address - Phone:661-377-1700
Mailing Address - Fax:661-616-9199
Practice Address - Street 1:7900 DISTRICT BLVD UNIT A
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93313-4845
Practice Address - Country:US
Practice Address - Phone:661-377-1700
Practice Address - Fax:661-616-9199
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT297427225100000X
MI5501017256225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist