Basic Information
| Provider Information | |||||||||
| NPI: | 1306866538 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WESP | ||||||||
| FirstName: | JOHN | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31108 GOVERNMENT DR | ||||||||
| Address2: | |||||||||
| City: | PEQUOT LAKES | ||||||||
| State: | MN | ||||||||
| PostalCode: | 564721001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3208394271 | ||||||||
| FaxNumber: | 3208394196 | ||||||||
| Practice Location | |||||||||
| Address1: | 15620 EDGEWOOD DRIVE | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | BAXTER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2184547012 | ||||||||
| FaxNumber: | 3208394196 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 04/11/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 4263 | MN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.