Provider Demographics
NPI:1437380060
Name:WETTERER, NANCY JANE (LMT, NCBTMB, CAP)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:JANE
Last Name:WETTERER
Suffix:
Gender:F
Credentials:LMT, NCBTMB, CAP
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 56983
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32241-6983
Mailing Address - Country:US
Mailing Address - Phone:513-314-6869
Mailing Address - Fax:
Practice Address - Street 1:8849 OLD KINGS RD S
Practice Address - Street 2:#146
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-1703
Practice Address - Country:US
Practice Address - Phone:513-314-6869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL.MA 40665225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist