Provider Demographics
NPI:1982324430
Name:WESLEY, NEHEMIAH M SR (PT)
Entity Type:Individual
Prefix:MR
First Name:NEHEMIAH
Middle Name:M
Last Name:WESLEY
Suffix:SR
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 1:7501 PECAN HILL CV
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-0935
Mailing Address - Country:US
Mailing Address - Phone:901-417-3770
Mailing Address - Fax:
Practice Address - Street 1:7501 PECAN HILL CV
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-0935
Practice Address - Country:US
Practice Address - Phone:901-417-3770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1339164225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA