Provider Demographics
NPI:1932275278
Name:WETTE, GILBERT W (PT)
Entity Type:Individual
Prefix:
First Name:GILBERT
Middle Name:W
Last Name:WETTE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 PETERSON ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-2917
Mailing Address - Country:US
Mailing Address - Phone:970-282-3751
Mailing Address - Fax:970-282-3720
Practice Address - Street 1:107 PETERSON ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-2917
Practice Address - Country:US
Practice Address - Phone:970-282-3751
Practice Address - Fax:970-282-3720
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4807225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC465188Medicare PIN