MEDICARE: DR. RICHARD WEISE II DPT

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	225100000X	Physical Therapist	PT34412	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1063571982	OTHER	FL	NPI

General Provider Information

NPI Number	:	1639357353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD WEISE II DPT

Provider Business Mailing Address
First Line	:	305 RAVEN ROCK LN
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32750-3836
Country	:	US
Telephone Number	:	407-280-7715
Fax Number	:

Provider Business Practice Location Address
First Line	:	521 W STATE ROAD 434 STE 204
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32750-5165
Country	:	US
Telephone Number	:	407-767-5842
Fax Number	:

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

Provider Enumeration Date	:	02/05/2008
Last Update Date	:	02/18/2025

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