Provider Demographics
NPI:1033689104
Name:WEIDENFELD, RAFAEL (DPT)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:
Last Name:WEIDENFELD
Suffix:
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 1:275 11TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3910
Mailing Address - Country:US
Mailing Address - Phone:347-886-4962
Mailing Address - Fax:
Practice Address - Street 1:235 SW 6TH AVE
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-2394
Practice Address - Country:US
Practice Address - Phone:360-678-5151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043835225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist