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Individual

ERIC L WESSEL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PT

Contact information

Practice address
2136 VADALABENE DR, MARYVILLE, IL 62062-5632
(618) 288-4677
(618) 288-4699
Mailing address
15 APEX DR, HIGHLAND, IL 62249-1282
(618) 651-0444
(618) 654-5439

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070012251
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
539018
HEALTHLINK
IL
01
P00099811
MEDICARE RAILROAD
IL
Enumeration date
06/21/2005
Last updated
09/04/2007
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