Healthcare Provider Details

I. General information

NPI: 1457385395
Provider Name (Legal Business Name): CHRISTINE E WEIKERT DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 S ALLEN ST SUITE 4
STATE COLLEGE PA
16801-5944
US

IV. Provider business mailing address

1333 S ALLEN ST SUITE 4
STATE COLLEGE PA
16801-5944
US

V. Phone/Fax

Practice location:
  • Phone: 814-231-0451
  • Fax: 814-231-1817
Mailing address:
  • Phone: 814-231-0451
  • Fax: 814-231-1817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC004314-L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberSC004314-L
License Number StatePA

VIII. Authorized Official

Name: DR. CHRISTINE E WEIKERT
Title or Position: PRESIDENT
Credential: DPM
Phone: 814-231-0451