Provider Demographics
NPI:1396110565
Name:BOND, WESLEY STEWART
Entity type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:STEWART
Last Name:BOND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2270 DALLAS ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80010-1069
Mailing Address - Country:US
Mailing Address - Phone:727-409-5498
Mailing Address - Fax:
Practice Address - Street 1:5191 S YOSEMITE ST STE B
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-3360
Practice Address - Country:US
Practice Address - Phone:303-577-9977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0018287225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist