Provider Demographics
NPI:1225811417
Name:WEYANDT, KATHERINE (DPT)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:
Last Name:WEYANDT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4215 RICHWOOD CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-6153
Mailing Address - Country:US
Mailing Address - Phone:331-330-5516
Mailing Address - Fax:
Practice Address - Street 1:1315 MACOM DR STE 105
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-9360
Practice Address - Country:US
Practice Address - Phone:630-369-8585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.027686225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist