Healthcare Provider Details

I. General information

NPI: 1407585300
Provider Name (Legal Business Name): WESLEY DORTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15051 HARMONY HILLS LN
ABINGDON VA
24211-7661
US

IV. Provider business mailing address

20076 GALEN DR
ABINGDON VA
24211-6948
US

V. Phone/Fax

Practice location:
  • Phone: 276-451-2590
  • Fax:
Mailing address:
  • Phone: 276-274-8459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306603228
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: