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NPI Code Detail

MEDICARE: JUDITH LEIGH WEGEHAUPT PT

MEDICARE: JUDITH LEIGH WEGEHAUPT 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
1225100000XPhysical Therapist1836-024WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255401675
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUDITH LEIGH WEGEHAUPT PT
Provider Business Mailing Address
First Line : 10579 FIELDCREST RD
Second Line :
City : SISTER BAY
State : WI
Zip : 54234-9188
Country : US
Telephone Number : 414-232-1018
Fax Number :
Provider Business Practice Location Address
First Line : 1673 DOUSMAN ST
Second Line :
City : GREEN BAY
State : WI
Zip : 54303-3209
Country : US
Telephone Number : 920-593-4326
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2006
Last Update Date : 03/12/2010

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Directions to “ JUDITH LEIGH WEGEHAUPT PT” Practice Location

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