Provider Demographics
NPI:1235321308
Name:WEIKER PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:WEIKER PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIKER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:608-850-6181
Mailing Address - Street 1:1001 ARBORETUM DR
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-2670
Mailing Address - Country:US
Mailing Address - Phone:608-850-6181
Mailing Address - Fax:608-850-6121
Practice Address - Street 1:1001 ARBORETUM DR
Practice Address - Street 2:SUITE 1A
Practice Address - City:WAUNAKEE
Practice Address - State:WI
Practice Address - Zip Code:53597-2670
Practice Address - Country:US
Practice Address - Phone:608-850-6181
Practice Address - Fax:608-850-6121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3961-024261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40424600Medicaid
WIP00368177OtherMEDICARE RAILROAD CARRIER
611150600OtherDEEOIC
WI40424600Medicaid
WI0000 80018Medicare PIN