Individual
KENNETH MICHAEL WETHERHOLT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CSFA
Contact information
Practice address
8626 TESORO DR STE 502, SAN ANTONIO, TX 78217-6217
(210) 496-2222
Mailing address
102 DEERWOOD DR, GROTON, CT 06340-2516
(850) 554-2346
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
246ZC0007X
Surgical Assistant
194476
—
Other
Enumeration date
09/15/2021
Last updated
07/31/2025
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