Provider Demographics
NPI:1730147174
Name:WEISBERG, MICHAEL (ATC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:WEISBERG
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:981 WHITNEY RANCH DR
Mailing Address - Street 2:APT 324
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2566
Mailing Address - Country:US
Mailing Address - Phone:847-370-7130
Mailing Address - Fax:
Practice Address - Street 1:981 WHITNEY RANCH DR
Practice Address - Street 2:APT 324
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2566
Practice Address - Country:US
Practice Address - Phone:847-370-7130
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV05061022255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer