Provider Demographics
NPI:1962937250
Name:WESLEY, MARC (LMT)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:WESLEY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 L ST NW
Mailing Address - Street 2:SUITE 607
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-5002
Mailing Address - Country:US
Mailing Address - Phone:202-528-7223
Mailing Address - Fax:
Practice Address - Street 1:1900 L ST NW
Practice Address - Street 2:SUITE 607
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-5002
Practice Address - Country:US
Practice Address - Phone:202-528-7223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
DCMT1561225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner