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General NPI Number Information
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NPI Number | 1841264504
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Entity Type | Individual
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Provider Name | KENT M WEISBECK ATC, LICENSED
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Gender | Male
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Dates
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Enumeration Date | 02/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1 WAR MEMORIAL SQ
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City | ROCHESTER
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State | NY
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Zip | 14614-2109
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Country | US
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Telephone | 585-454-5335
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Fax | 585-454-3954
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Provider Business Mailing Address
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Address Line | 36 MAYFAIR DR
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City | ROCHESTER
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State | NY
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Zip | 14617-3507
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Country | US
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Telephone | 585-338-9471
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Fax | 585-338-9471
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 000405-1
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License Number State | NY
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