Provider Demographics
NPI:1730456260
Name:WELLINGTON, JOSEA SHARLENE (PTA)
Entity Type:Individual
Prefix:
First Name:JOSEA
Middle Name:SHARLENE
Last Name:WELLINGTON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 WILLIE MAYS PKWY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-4558
Mailing Address - Country:US
Mailing Address - Phone:407-235-8210
Mailing Address - Fax:
Practice Address - Street 1:925 WILLIE MAYS PKWY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-4558
Practice Address - Country:US
Practice Address - Phone:407-235-8210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 22778225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant