MEDICARE: MARIA DOLORES WEISSERT

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	2251G0304X	Geriatric Physical Therapist	PT11998	FL

General Provider Information

NPI Number	:	1821474180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA DOLORES WEISSERT

Provider Business Mailing Address
First Line	:	4239 LA FRANCE AVE
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34286-6621
Country	:	US
Telephone Number	:	941-276-8093
Fax Number	:

Provider Business Practice Location Address
First Line	:	4239 LA FRANCE AVE
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34286-6621
Country	:	US
Telephone Number	:	941-276-8093
Fax Number	:

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

Provider Enumeration Date	:	08/09/2015
Last Update Date	:	08/09/2015

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Directions to “ MARIA DOLORES WEISSERT ” Practice Location

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