Provider Demographics
NPI:1598652307
Name:WEESE, BRENNON
Entity type:Individual
Prefix:
First Name:BRENNON
Middle Name:
Last Name:WEESE
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 1:616 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:WV
Mailing Address - Zip Code:26253-9615
Mailing Address - Country:US
Mailing Address - Phone:304-704-5936
Mailing Address - Fax:
Practice Address - Street 1:900 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3560
Practice Address - Country:US
Practice Address - Phone:304-621-7747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer