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General NPI Number Information
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NPI Number | 1609031020
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Entity Type | Individual
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Provider Name | ELIZABETH ANN WETZEL PTA
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Gender | Female
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Dates
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Enumeration Date | 07/24/2008
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Last Update Date | 07/24/2008
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Provider Practice Location Address
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Address Line | 1912 ST. RD 44
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City | NEW SYMRNA BEACH
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State | FL
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Zip | 32168-8345
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Country | US
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Telephone | 386-423-1070
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Fax | 386-423-0780
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Provider Business Mailing Address
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Address Line | 1912 STATE ROAD 44
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32168-8345
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Country | US
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Telephone | 386-423-1070
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 20878
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License Number State | FL
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