Provider Demographics
NPI:1376043182
Name:NORTHEY, WESLEY EDWARD IV (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:EDWARD
Last Name:NORTHEY
Suffix:IV
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 W GREEN ACRES RD
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-6133
Mailing Address - Country:US
Mailing Address - Phone:479-899-8206
Mailing Address - Fax:
Practice Address - Street 1:325 S 45TH ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1632
Practice Address - Country:US
Practice Address - Phone:479-899-8206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4382225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist