Provider Demographics
NPI:1144795774
Name:WEINGARTEN, CONNIE (PT, MHA)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:WEINGARTEN
Suffix:
Gender:F
Credentials:PT, MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 E BEAVER AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MORGAN
Mailing Address - State:CO
Mailing Address - Zip Code:80701-3104
Mailing Address - Country:US
Mailing Address - Phone:970-347-0220
Mailing Address - Fax:
Practice Address - Street 1:325 E BEAVER AVE
Practice Address - Street 2:
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-3104
Practice Address - Country:US
Practice Address - Phone:970-347-0220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2022-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2823225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist