Provider Demographics
NPI:1891887253
Name:WESSEL, BRIAN T (MPT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:T
Last Name:WESSEL
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:6880 S MCCARRAN BLVD
Mailing Address - Street 2:STE 13
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-6129
Mailing Address - Country:US
Mailing Address - Phone:775-399-4094
Mailing Address - Fax:775-201-6613
Practice Address - Street 1:6880 S MCCARRAN BLVD
Practice Address - Street 2:STE 13
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6129
Practice Address - Country:US
Practice Address - Phone:775-399-4094
Practice Address - Fax:775-210-6613
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT246762251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT24676Medicare PIN