Provider Demographics
NPI:1861240293
Name:MCCOOL, WESLEY (PTA)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:
Last Name:MCCOOL
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1386 PARKMAN PL
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45434-6937
Mailing Address - Country:US
Mailing Address - Phone:361-648-3635
Mailing Address - Fax:
Practice Address - Street 1:3775 BELLEAU WOOD DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-1804
Practice Address - Country:US
Practice Address - Phone:859-271-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA04470225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant