MEDICARE: MR. RANDY BRYAN WIEMER PT

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	PT7244	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

General Provider Information

NPI Number	:	1851350805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RANDY BRYAN WIEMER PT

Provider Business Mailing Address
First Line	:	4326 OKLAWAHA LN
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-1634
Country	:	US
Telephone Number	:	727-372-3437
Fax Number	:

Provider Business Practice Location Address
First Line	:	3488 E LAKE RD
Second Line	:	SUITE 301
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-2404
Country	:	US
Telephone Number	:	727-771-7377
Fax Number	:

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

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	07/08/2007

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