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General NPI Number Information
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NPI Number | 1104554369
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Entity Type | Individual
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Provider Name | COURTNEY WEIS PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 08/15/2022
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Last Update Date | 08/15/2022
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Provider Practice Location Address
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Address Line | 22342 W 66TH ST
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City | SHAWNEE
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State | KS
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Zip | 66226-3560
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Country | US
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Telephone | 913-728-6166
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Fax | 833-615-8216
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Provider Business Mailing Address
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Address Line | 625 KENMOOR AVE SE STE 100
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-2395
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Country | US
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Telephone | 616-356-5000
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Fax | 616-356-5001
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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 | 11-07114
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License Number State | KS
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