Provider Demographics
NPI:1275941387
Name:DUBOSE, WESLEY LOUIS CODY (DPT)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:LOUIS CODY
Last Name:DUBOSE
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 1:1550 TERRYS MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-8299
Mailing Address - Country:US
Mailing Address - Phone:276-224-9852
Mailing Address - Fax:
Practice Address - Street 1:301 LAVINDER ST
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-3520
Practice Address - Country:US
Practice Address - Phone:276-632-5281
Practice Address - Fax:276-632-6884
Is Sole Proprietor?:No
Enumeration Date:2014-08-01
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305208845225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist