Provider Demographics
NPI:1144375163
Name:WEIGEL, SHAWNALYN (M P T)
Entity type:Individual
Prefix:
First Name:SHAWNALYN
Middle Name:
Last Name:WEIGEL
Suffix:
Gender:F
Credentials:M P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 CENTER AVE # A
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-1015
Mailing Address - Country:US
Mailing Address - Phone:973-256-3295
Mailing Address - Fax:
Practice Address - Street 1:1025 MCBRIDE AVE
Practice Address - Street 2:
Practice Address - City:WEST PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07424-2534
Practice Address - Country:US
Practice Address - Phone:973-237-3275
Practice Address - Fax:973-237-1272
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00792500225100000X
CO6698225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist