Provider Demographics
NPI:1134407000
Name:HERDLEIN, WESLEY (PT)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:
Last Name:HERDLEIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9406 CHIMNEYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-2683
Mailing Address - Country:US
Mailing Address - Phone:770-500-8568
Mailing Address - Fax:
Practice Address - Street 1:9406 CHIMNEYWOOD DR
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75089-2683
Practice Address - Country:US
Practice Address - Phone:770-500-8568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1164919225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist