MEDICARE: AARON THOMAS WEIDENAAR PT, 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	1382982	TX

General Provider Information

NPI Number	:	1649054065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AARON THOMAS WEIDENAAR PT, DPT

Provider Business Mailing Address
First Line	:	2929 OAK LAWN AVE APT 544
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-5695
Country	:	US
Telephone Number	:	406-580-1409
Fax Number	:

Provider Business Practice Location Address
First Line	:	3535 TRAVIS ST STE 160
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-1428
Country	:	US
Telephone Number	:	214-346-9105
Fax Number	:

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

Provider Enumeration Date	:	08/24/2023
Last Update Date	:	08/28/2023

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