Provider Demographics
NPI:1245383025
Name:WEIDAUER, KURT D (DPT)
Entity Type:Individual
Prefix:MR
First Name:KURT
Middle Name:D
Last Name:WEIDAUER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1910 S 72ND ST
Mailing Address - Street 2:STE 302
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-1734
Mailing Address - Country:US
Mailing Address - Phone:402-391-2635
Mailing Address - Fax:402-391-0326
Practice Address - Street 1:1910 S 72ND ST
Practice Address - Street 2:STE 302
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-1734
Practice Address - Country:US
Practice Address - Phone:402-391-2635
Practice Address - Fax:402-391-0326
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE2464225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist