Provider Demographics
NPI:1912758541
Name:WETTSTEIN, COLIN (DPT)
Entity type:Individual
Prefix:
First Name:COLIN
Middle Name:
Last Name:WETTSTEIN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBURY
Mailing Address - State:IL
Mailing Address - Zip Code:61739-1550
Mailing Address - Country:US
Mailing Address - Phone:815-692-2270
Mailing Address - Fax:
Practice Address - Street 1:215 W LOCUST ST
Practice Address - Street 2:
Practice Address - City:FAIRBURY
Practice Address - State:IL
Practice Address - Zip Code:61739-1550
Practice Address - Country:US
Practice Address - Phone:815-692-2270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-028091208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation