Healthcare Provider Details

I. General information

NPI: 1073887857
Provider Name (Legal Business Name): JULIE ANNE WEIGAND LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2012
Last Update Date: 02/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 SWEET PEA LANE
POCONO PINES PA
18350
US

IV. Provider business mailing address

PO BOX 1074
POCONO PINES PA
18350-1074
US

V. Phone/Fax

Practice location:
  • Phone: 570-236-8978
  • Fax:
Mailing address:
  • Phone: 570-236-8978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMSG003538
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: