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General NPI Number Information
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NPI Number | 1316817406
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Entity Type | Individual
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Provider Name | EVAN JOSEPH WEGENAST PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 11/05/2025
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 128 BRECKENRIDGE LN
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City | LOUISVILLE
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State | KY
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Zip | 40207-4904
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Country | US
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Telephone | 502-537-7440
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Fax | 502-537-7441
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Provider Business Mailing Address
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Address Line | 128 BRECKENRIDGE LN
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City | LOUISVILLE
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State | KY
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Zip | 40207-4904
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Country | US
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Telephone | 502-537-7440
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Fax | 502-537-7441
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 009505
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 009505
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License Number State | KY
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