Provider Demographics
NPI:1942745815
Name:VESEL, JAMES (PTA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:VESEL
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12055 41ST AVE N
Mailing Address - Street 2:APT 206
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-1228
Mailing Address - Country:US
Mailing Address - Phone:612-219-1885
Mailing Address - Fax:
Practice Address - Street 1:707 BIELENBERG DR
Practice Address - Street 2:SUITE 108
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1426
Practice Address - Country:US
Practice Address - Phone:651-846-1952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-30
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA2078225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant