Provider Demographics
NPI:1134129703
Name:WEGGENMAN, JAMES ROBERT (PT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ROBERT
Last Name:WEGGENMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11320 NW RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-4069
Mailing Address - Country:US
Mailing Address - Phone:503-645-2646
Mailing Address - Fax:
Practice Address - Street 1:1515 NW 18TH AVE
Practice Address - Street 2:STE 400, PETTYGROVE PHYSICAL THERAPY AND SPORTS REHAB.
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2515
Practice Address - Country:US
Practice Address - Phone:503-228-1306
Practice Address - Fax:503-228-1307
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0575225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist