Healthcare Provider Details

I. General information

NPI: 1164632089
Provider Name (Legal Business Name): JOSEPH PAUL WEISHAPL PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 CONSTITUTION AVE NE
ALBUQUERQUE NM
87110-7613
US

IV. Provider business mailing address

3010 19TH AVE SE
RIO RANCHO NM
87124-1750
US

V. Phone/Fax

Practice location:
  • Phone: 505-291-2673
  • Fax:
Mailing address:
  • Phone: 505-896-8976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA-318
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: