Provider Demographics
NPI:1124005434
Name:WEINBERG, JONATHAN MICHAEL (PT, DIP MDT)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:MICHAEL
Last Name:WEINBERG
Suffix:
Gender:M
Credentials:PT, DIP MDT
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 1370
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-1370
Mailing Address - Country:US
Mailing Address - Phone:919-603-5400
Mailing Address - Fax:919-603-5404
Practice Address - Street 1:110 MAIN ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-3319
Practice Address - Country:US
Practice Address - Phone:919-603-5400
Practice Address - Fax:919-603-5404
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC69132251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7210971Medicaid
NC6913OtherSTATE LICENSE
NC6913OtherSTATE LICENSE