Provider Demographics
NPI:1164483756
Name:WIEGER, MICHELLE KAREN (PT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:KAREN
Last Name:WIEGER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 HECKS DR
Mailing Address - Street 2:
Mailing Address - City:DAUPHIN
Mailing Address - State:PA
Mailing Address - Zip Code:17018-9453
Mailing Address - Country:US
Mailing Address - Phone:717-921-9039
Mailing Address - Fax:
Practice Address - Street 1:450 POWERS AVE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-5933
Practice Address - Country:US
Practice Address - Phone:717-920-4950
Practice Address - Fax:717-920-4955
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006001L225100000X
NJ40QA01151700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101091817 0001Medicaid
PA101091817 0001Medicaid
PA189539R9XMedicare Oscar/Certification