Provider Demographics
NPI:1417645698
Name:FOOTE, WESLEY C (LMT)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:C
Last Name:FOOTE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 INTELCO LOOP SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-5941
Mailing Address - Country:US
Mailing Address - Phone:360-438-6425
Mailing Address - Fax:360-923-9382
Practice Address - Street 1:4525 INTELCO LOOP SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-5941
Practice Address - Country:US
Practice Address - Phone:360-438-6425
Practice Address - Fax:360-923-9382
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61348149225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist