Provider Demographics
NPI:1205844651
Name:WEISENBERGER, BOBBY WILSON (ATC)
Entity Type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:WILSON
Last Name:WEISENBERGER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 HOYLAKE CT
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-6863
Mailing Address - Country:US
Mailing Address - Phone:843-766-6976
Mailing Address - Fax:
Practice Address - Street 1:620 LONG POINT RD UNIT C
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-8282
Practice Address - Country:US
Practice Address - Phone:843-216-8822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7442255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer