Provider Demographics
NPI:1205952538
Name:WEIDA, JOHN C (ATC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:C
Last Name:WEIDA
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:MR
Other - First Name:JC
Other - Middle Name:
Other - Last Name:WEIDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6319 LONGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-3372
Mailing Address - Country:US
Mailing Address - Phone:406-251-1304
Mailing Address - Fax:
Practice Address - Street 1:32 CAMPUS DR
Practice Address - Street 2:RHINEHART ATC
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59812-0003
Practice Address - Country:US
Practice Address - Phone:406-243-6362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer