Provider Demographics
NPI:1144421025
Name:HOWELL, WANDA EDWARDS (PT)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:EDWARDS
Last Name:HOWELL
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 1:1076 N LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-8382
Mailing Address - Country:US
Mailing Address - Phone:919-938-7297
Mailing Address - Fax:919-989-7078
Practice Address - Street 1:514 N BRIGHTLEAF BLVD
Practice Address - Street 2:SUITE 1120
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4407
Practice Address - Country:US
Practice Address - Phone:919-938-7296
Practice Address - Fax:919-938-7078
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2381225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist