Provider Demographics
NPI:1073887857
Name:WEIGAND, JULIE ANNE (LMT)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ANNE
Last Name:WEIGAND
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1074
Mailing Address - Street 2:
Mailing Address - City:POCONO PINES
Mailing Address - State:PA
Mailing Address - Zip Code:18350-1074
Mailing Address - Country:US
Mailing Address - Phone:570-236-8978
Mailing Address - Fax:
Practice Address - Street 1:111 SWEET PEA LANE
Practice Address - Street 2:
Practice Address - City:POCONO PINES
Practice Address - State:PA
Practice Address - Zip Code:18350
Practice Address - Country:US
Practice Address - Phone:570-236-8978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG003538172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist