Provider Demographics
NPI:1275015802
Name:WETHERBEE, DANAE ELYCE (DPT)
Entity Type:Individual
Prefix:
First Name:DANAE
Middle Name:ELYCE
Last Name:WETHERBEE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 693
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:NY
Mailing Address - Zip Code:14506-0693
Mailing Address - Country:US
Mailing Address - Phone:585-243-9150
Mailing Address - Fax:585-243-4814
Practice Address - Street 1:4 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454-1445
Practice Address - Country:US
Practice Address - Phone:585-243-9150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043510225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist