Healthcare Provider Details

I. General information

NPI: 1366320608
Provider Name (Legal Business Name): NICHOLAS WEISHAR DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 S PURCELL BLVD STE 114
PUEBLO CO
81007-5083
US

IV. Provider business mailing address

N3957 LILLY RD
RUBICON WI
53078-9771
US

V. Phone/Fax

Practice location:
  • Phone: 719-547-2481
  • Fax: 719-547-2487
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1757224
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP061646T
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: