Provider Demographics
NPI:1366651408
Name:WEIS, NINA L (PT)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:L
Last Name:WEIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 MILLBURN AVE
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1825
Mailing Address - Country:US
Mailing Address - Phone:973-376-7100
Mailing Address - Fax:973-376-7101
Practice Address - Street 1:161 MILLBURN AVE
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1825
Practice Address - Country:US
Practice Address - Phone:973-376-7100
Practice Address - Fax:973-376-7101
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00550900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist