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General NPI Number Information
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NPI Number | 1023100146
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Entity Type | Individual
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Provider Name | BRADEN J WEGESIN PT
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Gender | Male
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 135 STETZER RD
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City | BUCYRUS
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State | OH
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Zip | 44820-2076
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Country | US
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Telephone | 419-562-4459
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Fax | 419-562-4478
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Provider Business Mailing Address
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Address Line | 944 BIDDLE RD
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City | GALION
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State | OH
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Zip | 44833-9329
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Country | US
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Telephone | 419-447-7203
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Fax | 419-447-5577
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 10295
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License Number State | OH
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