Individual
MRS. HEATHER R WEDGWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICAL THERAPIST
Contact information
Practice address
110 S US HWY 64/264, MANTEO, NC 27954
(252) 261-1556
(252) 261-6161
Mailing address
101 MEDICAL DR, ELIZABETH CITY, NC 27909-3361
(252) 338-2114
(252) 338-2115
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11072
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
068WU
BCBS
NC
05
—
7212329
—
NC
Enumeration date
07/02/2007
Last updated
06/25/2008
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