Provider Demographics
NPI:1366715997
Name:WETZEL, NEISHA I F (PT)
Entity type:Individual
Prefix:
First Name:NEISHA
Middle Name:I F
Last Name:WETZEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:NEISHA
Other - Middle Name:I
Other - Last Name:FLATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:501 EXECUTIVE PL
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5390
Mailing Address - Country:US
Mailing Address - Phone:901-423-5550
Mailing Address - Fax:910-423-5552
Practice Address - Street 1:501 EXECUTIVE PL
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5390
Practice Address - Country:US
Practice Address - Phone:901-423-5550
Practice Address - Fax:910-423-5552
Is Sole Proprietor?:No
Enumeration Date:2012-02-13
Last Update Date:2016-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP11715225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist