Provider Demographics
NPI:1255740270
Name:WEDEWER, WESLEY J (DPT)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:J
Last Name:WEDEWER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8813
Mailing Address - Country:US
Mailing Address - Phone:630-575-6250
Mailing Address - Fax:630-575-7450
Practice Address - Street 1:1500 WAUKEGAN RD
Practice Address - Street 2:SUITE 250
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-2100
Practice Address - Country:US
Practice Address - Phone:847-657-9445
Practice Address - Fax:847-657-9450
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011622225100000X
IL070022161225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist