Provider Demographics
NPI:1790212777
Name:DAVID L WETZEL LLC
Entity Type:Organization
Organization Name:DAVID L WETZEL LLC
Other - Org Name:IN HOME PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES./OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:WETZEL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:801-448-1770
Mailing Address - Street 1:12403 S DOREEN DR
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-4360
Mailing Address - Country:US
Mailing Address - Phone:801-448-1770
Mailing Address - Fax:801-877-5356
Practice Address - Street 1:12403 S DOREEN DR
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-4360
Practice Address - Country:US
Practice Address - Phone:801-448-1770
Practice Address - Fax:801-877-5356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT106687-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1306840129Medicaid