Stephnie Wedderburn, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT003217 Issued in GA

Practice address

368 W Pike St
Suite 204-a
Lawrenceville, GA 30045-3240

Phone

(770) 755-5278

Fax

(770) 755-5682

NPI assigned

Dec 21, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Georgia Luna Care Physical Therapy LLC

  • Physical Therapist
  • Atlanta, GA
  • NPI 1245826999
  Medicare reassignment
• Therapy Medical-Wellness Centers, LLC

  • Physical Therapy Clinic/Center
  • Lawrenceville, GA
  • NPI 1124142013
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1198195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1198195200000",
    "number": "1124202494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "368 W PIKE ST",
            "address_2": "SUITE 204-A",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300453240",
            "telephone_number": "770-755-5278",
            "fax_number": "770-755-5682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "368 W PIKE ST",
            "address_2": "SUITE 204-A",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300453240",
            "telephone_number": "770-755-5278",
            "fax_number": "770-755-5682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEDDERBURN",
        "first_name": "STEPHNIE",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-12-21",
        "last_updated": "2007-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT003217",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alissa Elaine Wayne, LCSW
• Fatoumata Waziri
• We DO Care, Inc.
• Vida A Weaver, RN
• Patricia Webb, MS
• Connie Wei
• Christopher James Weigel, PA-C
• Karen Weil, EDS.,CCC-SLP
• Adam Weinberg, M.D.
• Paul B Weinberg, MD

• Physical Therapist in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.