Provider Demographics
NPI:1528198215
Name:WEZEL, MICHAEL JOHN
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOHN
Last Name:WEZEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ARROW DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-2039
Mailing Address - Country:US
Mailing Address - Phone:781-935-2655
Mailing Address - Fax:781-935-2655
Practice Address - Street 1:119 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1728
Practice Address - Country:US
Practice Address - Phone:781-871-9500
Practice Address - Fax:781-871-9525
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027303225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist