Provider Demographics
NPI:1851819429
Name:MINTON, WESLEY BRANT (DPT)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:BRANT
Last Name:MINTON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 E BOGARD RD STE B203
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6570
Mailing Address - Country:US
Mailing Address - Phone:907-376-2203
Mailing Address - Fax:907-376-2213
Practice Address - Street 1:3400 LATOUCHE ST STE 200
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4208
Practice Address - Country:US
Practice Address - Phone:907-563-2122
Practice Address - Fax:907-563-2123
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK125841225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist