Provider Demographics
NPI:1518209188
Name:WESEL, COLLEEN STACY (PT)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:STACY
Last Name:WESEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2941 NE 1ST CT
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-2097
Mailing Address - Country:US
Mailing Address - Phone:503-693-6427
Mailing Address - Fax:
Practice Address - Street 1:4150 PACIFIC AVE STE 100
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-2786
Practice Address - Country:US
Practice Address - Phone:503-357-1706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3267225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist