Active NPI
Wesley Vaughn Rissell, PT, DPT
- Physical Therapist
- Draper, UT
National Provider Identifier
1467194241
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- P17440
- Practice address
- 65 E Wadsworth Park Dr Ste 230
Draper, UT 84020-8096 - Phone
- (385) 308-8034
- NPI assigned
- Apr 11, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | P17440 | NC | Primary |
Addresses
Primary practice location
65 E Wadsworth Park Dr Ste 230
Draper, UT 84020-8096
Mailing address
1611 Valley Run
Durham, NC 27707-3669
Phone (484) 678-3377
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P17440 | NC | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1649635200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1649635200000",
"number": "1467194241",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1611 VALLEY RUN",
"city": "DURHAM",
"state": "NC",
"postal_code": "277073669",
"telephone_number": "484-678-3377"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "65 E WADSWORTH PARK DR STE 230",
"city": "DRAPER",
"state": "UT",
"postal_code": "840208096",
"telephone_number": "385-308-8034"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RISSELL",
"first_name": "WESLEY",
"middle_name": "VAUGHN",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-04-11",
"last_updated": "2022-04-11",
"certification_date": "2022-04-11",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NC",
"license": "P17440",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Draper, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.