Provider Demographics
NPI:1639357353
Name:WEISE, RICHARD II (DPT)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:WEISE
Suffix:II
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 RAVEN ROCK LN
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-3836
Mailing Address - Country:US
Mailing Address - Phone:407-280-7715
Mailing Address - Fax:
Practice Address - Street 1:521 W STATE ROAD 434 STE 204
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5165
Practice Address - Country:US
Practice Address - Phone:407-767-5842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT34412225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL885796200Medicaid
FL888980500Medicaid
FL1063571982OtherNPI