Provider Demographics
NPI:1700315546
Name:WRIGHTSVILLE BEACH PHYSICAL THERAPY L.L.C.
Entity type:Organization
Organization Name:WRIGHTSVILLE BEACH PHYSICAL THERAPY L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:B
Authorized Official - Last Name:WEISLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:910-679-6024
Mailing Address - Street 1:PO BOX 1172
Mailing Address - Street 2:
Mailing Address - City:WRIGHTSVILLE BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28480
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:206 CAUSEWAY DRIVE
Practice Address - Street 2:PO BOX 1172
Practice Address - City:WRIGHTSVILLE BEACH
Practice Address - State:NC
Practice Address - Zip Code:28480
Practice Address - Country:US
Practice Address - Phone:910-679-6024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-06
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP11093225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty