Provider Demographics
NPI:1417034778
Name:WEEZORAK, CAROL WILDER (PT)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:WILDER
Last Name:WEEZORAK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:WILDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:264 WINDING WAY
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-8463
Mailing Address - Country:US
Mailing Address - Phone:717-737-4344
Mailing Address - Fax:717-737-4344
Practice Address - Street 1:55 MILLER ST
Practice Address - Street 2:CAPITAL AREA INTERMEDIATE UNIT
Practice Address - City:SUMMERDALE
Practice Address - State:PA
Practice Address - Zip Code:17093-0489
Practice Address - Country:US
Practice Address - Phone:717-732-8400
Practice Address - Fax:717-732-8414
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT002997L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist