Healthcare Provider Details

I. General information

NPI: 1780122895
Provider Name (Legal Business Name): DIANA WEIGLEIN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 JAMES SIMPSON JR WAY PHYSICAL THERAPY
COVINGTON KY
41011-0801
US

IV. Provider business mailing address

1500 JAMES SIMPSON JR WAY PHYSICAL THERAPY
COVINGTON KY
41011-0801
US

V. Phone/Fax

Practice location:
  • Phone: 859-655-4268
  • Fax: 859-655-1697
Mailing address:
  • Phone: 859-655-4268
  • Fax: 859-655-1697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA00168
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: