Provider Demographics
NPI:1942254461
Name:WESSELS, ELIZABETH MARIA (LPT,CFT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARIA
Last Name:WESSELS
Suffix:
Gender:F
Credentials:LPT,CFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 EAGLE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-8752
Mailing Address - Country:US
Mailing Address - Phone:318-397-1538
Mailing Address - Fax:318-340-9879
Practice Address - Street 1:408 N 6TH ST
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-4102
Practice Address - Country:US
Practice Address - Phone:318-340-9877
Practice Address - Fax:318-340-9879
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA02082F225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CM89Medicare ID - Type Unspecified