Provider Demographics
NPI:1467755793
Name:WEINERT, JANICE PATRICIA (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:PATRICIA
Last Name:WEINERT
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12411 NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-1740
Mailing Address - Country:US
Mailing Address - Phone:718-945-4099
Mailing Address - Fax:
Practice Address - Street 1:12411 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-1740
Practice Address - Country:US
Practice Address - Phone:718-945-4099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020482-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist