MEDICARE: JOHN G WETZEL PTA, LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	05651	OH

General Provider Information

NPI Number	:	1457208647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN G WETZEL PTA, LMT

Provider Business Mailing Address
First Line	:	36060 EUCLID AVE STE 105
Second Line	:
City	:	WILLOUGHBY
State	:	OH
Zip	:	44094-4661
Country	:	US
Telephone Number	:	440-953-6036
Fax Number	:	440-953-6126

Provider Business Practice Location Address
First Line	:	36060 EUCLID AVE STE 105
Second Line	:
City	:	WILLOUGHBY
State	:	OH
Zip	:	44094-4661
Country	:	US
Telephone Number	:	440-953-6036
Fax Number	:	440-953-6126

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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