Provider Demographics
NPI:1316371222
Name:DONALDSON, WES YEISER (PTA)
Entity Type:Individual
Prefix:MR
First Name:WES
Middle Name:YEISER
Last Name:DONALDSON
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 1:183 LONG VUE DR.
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:38485
Mailing Address - Country:US
Mailing Address - Phone:931-722-0916
Mailing Address - Fax:
Practice Address - Street 1:183 LONG VUE
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:TN
Practice Address - Zip Code:38485
Practice Address - Country:US
Practice Address - Phone:931-722-0916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA0000005447225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant