Provider Demographics
NPI:1003945635
Name:WESENBERG, JASON ALLEN (PT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:ALLEN
Last Name:WESENBERG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 3RD AVE
Mailing Address - Street 2:CENTRACARE CLINIC
Mailing Address - City:ALBANY
Mailing Address - State:MN
Mailing Address - Zip Code:56307-9363
Mailing Address - Country:US
Mailing Address - Phone:320-845-2157
Mailing Address - Fax:320-845-6138
Practice Address - Street 1:320 3RD AVE
Practice Address - Street 2:CENTRACARE CLINIC ALBANY
Practice Address - City:ALBANY
Practice Address - State:MN
Practice Address - Zip Code:56307-9363
Practice Address - Country:US
Practice Address - Phone:320-845-2157
Practice Address - Fax:320-845-6138
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6259225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist