MEDICARE: DR. MICHAEL ALEXANDER WEINAND DPT

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	PT025255	PA

General Provider Information

NPI Number	:	1336592286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL ALEXANDER WEINAND DPT

Provider Business Mailing Address
First Line	:	2122 SPRUCE ST APT 101
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-2556
Country	:	US
Telephone Number	:	520-780-1834
Fax Number	:

Provider Business Practice Location Address
First Line	:	2122 SPRUCE ST APT 101
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-2556
Country	:	US
Telephone Number	:	520-780-1834
Fax Number	:

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

Provider Enumeration Date	:	07/15/2016
Last Update Date	:	07/15/2016

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