Healthcare Provider Details

I. General information

NPI: 1679760961
Provider Name (Legal Business Name): MISS CAROL WEIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 12/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 WEYMAN RD PITTSBURGH
PITTSBURGH PA
15236-1584
US

IV. Provider business mailing address

1108 TROST AVE
PITTSBURGH PA
15210-3500
US

V. Phone/Fax

Practice location:
  • Phone: 412-884-3500
  • Fax: 412-884-1700
Mailing address:
  • Phone: 412-884-6283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTE005743L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: