Provider Demographics
NPI:1902274442
Name:WEIGAND, PATRICK (PTA)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:WEIGAND
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9494 E REDFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3757
Mailing Address - Country:US
Mailing Address - Phone:480-242-8717
Mailing Address - Fax:
Practice Address - Street 1:9494 E REDFIELD RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-3757
Practice Address - Country:US
Practice Address - Phone:480-242-8717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR#09139225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant