MEDICARE: DR. ALLAN WETZEL DPT

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	225100000X	Physical Therapist	PT-3867	ID

General Provider Information

NPI Number	:	1568857753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLAN WETZEL DPT

Provider Business Mailing Address
First Line	:	1003 RIVER ST
Second Line	:	SUITE C
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-1754
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1003 RIVER ST
Second Line	:	SUITE C
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-1754
Country	:	US
Telephone Number	:	831-457-1800
Fax Number	:

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

Provider Enumeration Date	:	04/03/2015
Last Update Date	:	02/11/2022

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