Healthcare Provider Details

I. General information

NPI: 1255001038
Provider Name (Legal Business Name): CARLETON LLOYD WEIDEMEYER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7045 EVERGREEN WOODS TRL
SPRING HILL FL
34608-1306
US

IV. Provider business mailing address

5407 PANAMA AVE
SPRING HILL FL
34609-1336
US

V. Phone/Fax

Practice location:
  • Phone: 727-614-1431
  • Fax:
Mailing address:
  • Phone: 727-614-1431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA31448
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: