Provider Demographics
NPI:1285015628
Name:YATES, WESLEY RUSSELL (DPT)
Entity Type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:RUSSELL
Last Name:YATES
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 288
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-0288
Mailing Address - Country:US
Mailing Address - Phone:731-587-3422
Mailing Address - Fax:731-587-3424
Practice Address - Street 1:104 OXFORD ST
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237-2428
Practice Address - Country:US
Practice Address - Phone:731-587-3422
Practice Address - Fax:731-587-3424
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10069225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN10096OtherLICENSE NUMBER