Healthcare Provider Details

I. General information

NPI: 1275459497
Provider Name (Legal Business Name): WILLIAM MICHAEL WESLEY DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 AMERICAN WAY
WEIRTON WV
26062-4082
US

IV. Provider business mailing address

171 AMERICAN WAY
WEIRTON WV
26062-4082
US

V. Phone/Fax

Practice location:
  • Phone: 304-797-6104
  • Fax: 304-797-6421
Mailing address:
  • Phone: 304-797-6104
  • Fax: 304-797-6421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT013090
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT002926
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: