MEDICARE: MR. THOMAS J WEISSENBERGER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA-2631	ID
2	363A00000X	Physician Assistant	PA60299170	WA

General Provider Information

NPI Number	:	1407830383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS J WEISSENBERGER PA-C

Provider Business Mailing Address
First Line	:	3000 LIMITED LANE NW
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502
Country	:	US
Telephone Number	:	360-357-9392
Fax Number	:	360-528-3049

Provider Business Practice Location Address
First Line	:	3000 LIMITED LANE NW
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502
Country	:	US
Telephone Number	:	360-357-9392
Fax Number	:	360-528-3049

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2005
Last Update Date	:	04/06/2026

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