Provider Demographics
NPI:1093316069
Name:WECKBACH, KARA ELISE
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:ELISE
Last Name:WECKBACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 THORNBERRY RD
Mailing Address - Street 2:
Mailing Address - City:AMELIA
Mailing Address - State:OH
Mailing Address - Zip Code:45102-1721
Mailing Address - Country:US
Mailing Address - Phone:513-312-4749
Mailing Address - Fax:
Practice Address - Street 1:6405 SMALL HOUSE CIR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-7524
Practice Address - Country:US
Practice Address - Phone:513-312-4749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT014712225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist