Provider Demographics
NPI:1902886906
Name:WEIGEL, MARJORIE J (PT)
Entity Type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:J
Last Name:WEIGEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1426 6TH AVE
Mailing Address - Street 2:SUITE 100 CENTENNIAL BUILDING
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-2421
Mailing Address - Country:US
Mailing Address - Phone:304-523-4555
Mailing Address - Fax:304-525-1736
Practice Address - Street 1:1426 6TH AVE
Practice Address - Street 2:SUITE 100 CENTENNIAL BUILDING
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-2421
Practice Address - Country:US
Practice Address - Phone:304-523-4555
Practice Address - Fax:304-525-1736
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV255225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0157256000Medicaid
OH0502432Medicaid
KY8700072500Medicaid
OH0502432Medicaid