MEDICARE: PATRICIA WIESNER PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	070003265	IL

General Provider Information

NPI Number	:	1144322256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA WIESNER PT

Provider Business Mailing Address
First Line	:	PO BOX 591
Second Line	:
City	:	O FALLON
State	:	IL
Zip	:	62269-0591
Country	:	US
Telephone Number	:	618-632-9120
Fax Number	:	618-551-2697

Provider Business Practice Location Address
First Line	:	1567 SINKING SPRINGS DR
Second Line	:
City	:	O FALLON
State	:	IL
Zip	:	62269-6658
Country	:	US
Telephone Number	:	618-632-9120
Fax Number	:	618-551-2697

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	03/28/2019

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Directions to “ PATRICIA WIESNER PT” Practice Location

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