Provider Demographics
NPI:1457130098
Name:WAYSOME DREWERY, LYNETTE GLADYS (LMT)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:GLADYS
Last Name:WAYSOME DREWERY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:LYNETTE
Other - Middle Name:
Other - Last Name:WAYSOME DREWERY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:517 BARTON ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-4001
Mailing Address - Country:US
Mailing Address - Phone:919-943-7338
Mailing Address - Fax:
Practice Address - Street 1:4731 NC HIGHWAY 55 # 7A
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-2256
Practice Address - Country:US
Practice Address - Phone:919-937-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13088225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist