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General NPI Number Information
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NPI Number | 1033406830
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Entity Type | Individual
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Provider Name | KIMBERLY ROSE WIECHMANN D.P.T
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Gender | Female
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Dates
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Enumeration Date | 06/30/2011
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Last Update Date | 09/08/2018
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Provider Practice Location Address
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Address Line | 15751 SAN CARLOS BLVD
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City | FORT MYERS
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State | FL
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Zip | 33908-3314
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Country | US
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Telephone | 339-237-3729
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Fax |
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Provider Business Mailing Address
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Address Line | W125 OOSTY AVE
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City | OCONOMOWOC
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State | WI
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Zip | 53066-5532
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Country | US
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Telephone | 262-424-0267
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 11809-24
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License Number State | WI
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