Healthcare Provider Details

I. General information

NPI: 1649514274
Provider Name (Legal Business Name): ANDREA SABINE WIEGER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2012
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 W WASHINGTON BLVD STE 305
CHICAGO IL
60661-2137
US

IV. Provider business mailing address

509 W ROSCOE ST APT BB
CHICAGO IL
60657-3542
US

V. Phone/Fax

Practice location:
  • Phone: 773-216-4567
  • Fax:
Mailing address:
  • Phone: 847-256-2890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070010468
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: