Provider Demographics
NPI:1366443897
Name:WEYANT, TIM SCOTT (PT)
Entity Type:Individual
Prefix:MR
First Name:TIM
Middle Name:SCOTT
Last Name:WEYANT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 W SAMPLE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4048
Mailing Address - Country:US
Mailing Address - Phone:954-341-7875
Mailing Address - Fax:954-341-7895
Practice Address - Street 1:9900 W SAMPLE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4048
Practice Address - Country:US
Practice Address - Phone:954-341-7875
Practice Address - Fax:954-341-7895
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18132225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY9130ZMedicare ID - Type UnspecifiedPHYSICAL THERAPIST