Provider Demographics
NPI:1316045032
Name:WETSELL, ROGER W (PT)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:W
Last Name:WETSELL
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 1:2 DATE CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT SINAI
Mailing Address - State:NY
Mailing Address - Zip Code:11766-1804
Mailing Address - Country:US
Mailing Address - Phone:631-928-5101
Mailing Address - Fax:
Practice Address - Street 1:300 HALLOCK AVE
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-1227
Practice Address - Country:US
Practice Address - Phone:631-331-1070
Practice Address - Fax:631-331-1126
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0022662251X0800X
NH26342251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic