Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1850 | NE |
N | 2251P0200X | Physical Therapist - Pediatrics | 1850 | NE |
NPI | 1053573410 |
---|---|
Provider Name | Michelle Lynn Weimer |
First Address | Sidney, NE 69162-0031 |
Second Address | Sidney, NE 69162-1425 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2008 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10025780200 | (05) | NE |
10026468501 | (05) | NE |