Healthcare Provider Details

I. General information

NPI: 1982713400
Provider Name (Legal Business Name): JEREMY LUKE WEHKING P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 SW 74TH ST STE 201
SOUTH MIAMI FL
33143-5150
US

IV. Provider business mailing address

8381 SW 164TH ST
PALMETTO BAY FL
33157-3640
US

V. Phone/Fax

Practice location:
  • Phone: 305-433-1172
  • Fax: 305-726-0003
Mailing address:
  • Phone: 305-433-1172
  • Fax: 305-433-1172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT25605
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number21922
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11056
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT32725
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: