Provider Demographics
NPI:1649347188
Name:WESELY, LINDA ANN (PT)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:ANN
Last Name:WESELY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:LINDA
Other - Middle Name:ANN
Other - Last Name:HEBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1649 DIAMOND WOODS CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747
Mailing Address - Country:US
Mailing Address - Phone:916-543-0651
Mailing Address - Fax:
Practice Address - Street 1:1139 CIRBY WAY
Practice Address - Street 2:SIERRA HILLS CARE CENTER
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661
Practice Address - Country:US
Practice Address - Phone:916-784-3707
Practice Address - Fax:916-782-9758
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist