Healthcare Provider Details

I. General information

NPI: 1841873189
Provider Name (Legal Business Name): WESLEY KEITH HUTTON PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2097 N DECATUR RD
DECATUR GA
30033-5305
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 404-634-7171
  • Fax: 404-634-7176
Mailing address:
  • Phone: 423-238-7217
  • Fax: 423-238-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT014410
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: