Provider Demographics
NPI:1861045213
Name:COLLEEN WESEL PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:COLLEEN WESEL PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PT
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:STACY
Authorized Official - Last Name:WESEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-953-5853
Mailing Address - Street 1:3000 NE STUCKI AVE STE 230P
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-7107
Mailing Address - Country:US
Mailing Address - Phone:503-953-5853
Mailing Address - Fax:503-690-0678
Practice Address - Street 1:3000 NE STUCKI AVE STE 230P
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-7107
Practice Address - Country:US
Practice Address - Phone:503-953-5853
Practice Address - Fax:503-690-0678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-24
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty