Active NPI
Charles Patrick Wettach, PT
- Physical Therapist
- South Lake Tahoe, CA
National Provider Identifier
1962834291
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 42270
- Practice address
- 2170 South Ave
South Lake Tahoe, CA 96150-7026 - Phone
- (530) 543-5896
- Fax
- (530) 544-6512
- NPI assigned
- Aug 9, 2013
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 3162 | NV | |
| Physical Therapist | 225100000X | 42270 | CA | Primary |
Addresses
Primary practice location
2170 South Ave
South Lake Tahoe, CA 96150-7026
Mailing address
PO Box 9578
South Lake Tahoe, CA 96158-9578
Phone (530) 543-5896
Other practice location 1
155 Highway 50 Fl 2
Stateline, NV 89449-9816
Phone (775) 589-8953
Other practice location 2
1139 3rd St
South Lake Tahoe, CA 96150-3465
Phone (530) 543-5706
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 |
|---|---|---|---|
| 42270 | CA | MD | General Practice Dentistry |
| 3162 | NV | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1376006400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1962834291",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 9578",
"city": "SOUTH LAKE TAHOE",
"state": "CA",
"postal_code": "961589578",
"telephone_number": "530-543-5896",
"fax_number": "530-544-6512"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2170 SOUTH AVE",
"city": "SOUTH LAKE TAHOE",
"state": "CA",
"postal_code": "961507026",
"telephone_number": "530-543-5896",
"fax_number": "530-544-6512"
}
],
"practiceLocations": [
{
"address_1": "155 Highway 50 Fl 2",
"address_purpose": "LOCATION",
"city": "Stateline",
"state": "NV",
"postal_code": "894499816",
"country_code": "US",
"telephone_number": "775-589-8953",
"fax_number": "775-589-8920",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1139 3rd St",
"address_purpose": "LOCATION",
"city": "South Lake Tahoe",
"state": "CA",
"postal_code": "961503465",
"country_code": "US",
"telephone_number": "530-543-5706",
"fax_number": "530-541-4130",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WETTACH",
"first_name": "CHARLES",
"middle_name": "PATRICK",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-08-09",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NV",
"license": "3162",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "42270",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Lake Tahoe, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.