Provider Demographics
NPI:1144509787
Name:WEIDOW, ALEXIS NICOLE (DPT)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:NICOLE
Last Name:WEIDOW
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17053-1510
Mailing Address - Country:US
Mailing Address - Phone:717-903-9305
Mailing Address - Fax:
Practice Address - Street 1:310 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17053-1510
Practice Address - Country:US
Practice Address - Phone:717-903-9305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-14
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT020796225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist