MEDICARE: MRS. JUDY LYNN WIEGAND PHYSICAL THERAPIST

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	003061	KY

General Provider Information

NPI Number	:	1700091444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JUDY LYNN WIEGAND PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	921 CANNONS LN
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-4343
Country	:	US
Telephone Number	:	502-894-9700
Fax Number	:

Provider Business Practice Location Address
First Line	:	921 CANNONS LN
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-4343
Country	:	US
Telephone Number	:	502-894-9700
Fax Number	:

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

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	07/08/2007

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