Provider Demographics
NPI:1306294434
Name:JUNEAU, WESLEY MALCOLM (PT, DPT)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:MALCOLM
Last Name:JUNEAU
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-4915
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:12627 AIRLINE HWY STE A
Practice Address - Street 2:
Practice Address - City:DESTREHAN
Practice Address - State:LA
Practice Address - Zip Code:70047-2550
Practice Address - Country:US
Practice Address - Phone:985-603-4157
Practice Address - Fax:985-603-4242
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09378225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist