Provider Demographics
NPI:1457450496
Name:WEYGANDT, ERIC WRIGHT (DPT, CSCS)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:WRIGHT
Last Name:WEYGANDT
Suffix:
Gender:M
Credentials:DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5960 TANUS CIR
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-4303
Mailing Address - Country:US
Mailing Address - Phone:916-625-0855
Mailing Address - Fax:
Practice Address - Street 1:6815 FIVE STAR BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-2688
Practice Address - Country:US
Practice Address - Phone:916-630-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28712225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist