Provider Demographics
NPI:1114067428
Name:WEDDELL, KATY MULLIGAN (PT)
Entity Type:Individual
Prefix:MRS
First Name:KATY
Middle Name:MULLIGAN
Last Name:WEDDELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S CROSS ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-1569
Mailing Address - Country:US
Mailing Address - Phone:410-778-3900
Mailing Address - Fax:
Practice Address - Street 1:210 S CROSS ST
Practice Address - Street 2:SUITE 103
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-1569
Practice Address - Country:US
Practice Address - Phone:410-778-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17921225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD11140067428Medicare PIN