Provider Demographics
NPI:1033420518
Name:WEISS, ILYZA BRIENNE (PT, DPT, CERT MDT)
Entity Type:Individual
Prefix:DR
First Name:ILYZA
Middle Name:BRIENNE
Last Name:WEISS
Suffix:
Gender:F
Credentials:PT, DPT, CERT MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 WINDFLOWER CT
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-1772
Mailing Address - Country:US
Mailing Address - Phone:304-685-4399
Mailing Address - Fax:
Practice Address - Street 1:631 WINDFLOWER CT
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-1772
Practice Address - Country:US
Practice Address - Phone:304-685-4399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030505-1225100000X
NJ40QA01292200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist