Provider Demographics
NPI:1235485160
Name:POETKER, MARY WEDDINGTON (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:WEDDINGTON
Last Name:POETKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2372 EAGLE DR NE
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-9497
Mailing Address - Country:US
Mailing Address - Phone:828-695-6469
Mailing Address - Fax:828-464-5800
Practice Address - Street 1:301 10TH ST NW
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-2419
Practice Address - Country:US
Practice Address - Phone:828-695-6469
Practice Address - Fax:828-464-5800
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-29
Last Update Date:2012-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NCPT1892225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist