Individual
LARRY WESSEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
12883 109TH ST, LARGO, FL 33778-2117
(727) 244-0369
Mailing address
12883 109TH ST, LARGO, FL 33778-2117
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
PTA193
FL
Other
Enumeration date
01/10/2012
Last updated
01/10/2012
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