Provider Demographics
NPI:1366614091
Name:ELFORD, WESLEY JEFF (PT)
Entity type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:JEFF
Last Name:ELFORD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N2255 COUNTY ROAD I
Mailing Address - Street 2:
Mailing Address - City:MARKESAN
Mailing Address - State:WI
Mailing Address - Zip Code:53946-7313
Mailing Address - Country:US
Mailing Address - Phone:920-398-2751
Mailing Address - Fax:920-398-3937
Practice Address - Street 1:1130 N MARGARET ST
Practice Address - Street 2:
Practice Address - City:MARKESAN
Practice Address - State:WI
Practice Address - Zip Code:53946-8516
Practice Address - Country:US
Practice Address - Phone:920-398-2751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9524-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40462400Medicaid