Provider Demographics
NPI:1255404661
Name:WETZLER, MARY MARGARET (PT)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:MARGARET
Last Name:WETZLER
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:142 KREUZER LN
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-3606
Mailing Address - Country:US
Mailing Address - Phone:707-255-4983
Mailing Address - Fax:
Practice Address - Street 1:1103 TRANCAS ST
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2907
Practice Address - Country:US
Practice Address - Phone:707-224-3131
Practice Address - Fax:707-224-2356
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT5803225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA261QP2000XMedicare ID - Type UnspecifiedTAXONOMY
CA00PT5803Medicare ID - Type UnspecifiedPHYSICAL THERAPY