Provider Demographics
NPI:1962767772
Name:WETZEL, DENISE (DPT)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:WETZEL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:
Other - Last Name:ENEBO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:4204 BOULDER RIDGE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-6162
Mailing Address - Country:US
Mailing Address - Phone:406-480-4261
Mailing Address - Fax:
Practice Address - Street 1:4204 BOULDER RIDGE RD STE 100
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-6162
Practice Address - Country:US
Practice Address - Phone:701-751-3064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1643225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist