Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2305208899 | VA |
NPI | 1003216300 |
---|---|
Provider Name | Thomas Weniger |
First Address | Newport News, VA 23606-3074 |
Second Address | Newport News, VA 23606-3074 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2014 |
Last Update Date | 25/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2305208899 | LICENSE (01) | VA |