Healthcare Provider Details

I. General information

NPI: 1578132338
Provider Name (Legal Business Name): WESAM MAAIAH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2021
Last Update Date: 06/24/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 LEETSDALE DR
DENVER CO
80224-1588
US

IV. Provider business mailing address

6800 LEETSDALE DR
DENVER CO
80224-1588
US

V. Phone/Fax

Practice location:
  • Phone: 303-331-9963
  • Fax:
Mailing address:
  • Phone: 303-331-9963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number0014641
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: