Provider Demographics
NPI:1457486011
Name:WIEGANDT, KAREN SUZANNE (MPT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:SUZANNE
Last Name:WIEGANDT
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 N ACCESS RD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34224-8655
Mailing Address - Country:US
Mailing Address - Phone:941-375-8183
Mailing Address - Fax:941-218-5627
Practice Address - Street 1:1200 OAKLEY SEAVER DR.
Practice Address - Street 2:SUITE 204
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711
Practice Address - Country:US
Practice Address - Phone:352-241-0347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18382225100000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty