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NPI Code Detail

MEDICARE: NICHOLAS WEISHAR

MEDICARE: NICHOLAS WEISHAR
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 Therapist2305217384VA
2225100000XPhysical Therapist14116MN
3225100000XPhysical TherapistCP053045TSC

General Provider Information

NPI Number : 1366320608
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLAS WEISHAR
Provider Business Mailing Address
First Line : N3957 LILLY RD
Second Line :
City : RUBICON
State : WI
Zip : 53078-9771
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 210 VILLAGE CENTER BLVD STE 100
Second Line :
City : MYRTLE BEACH
State : SC
Zip : 29579-6706
Country : US
Telephone Number : 843-353-3460
Fax Number : 843-353-3461
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2025
Last Update Date : 03/10/2026

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Directions to “ NICHOLAS WEISHAR ” Practice Location

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