Provider Demographics
NPI:1497741896
Name:WIEDERIEN, ROBERT C (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:WIEDERIEN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 CHAD CT
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-3228
Mailing Address - Country:US
Mailing Address - Phone:808-295-3309
Mailing Address - Fax:
Practice Address - Street 1:500 NEWTON RD
Practice Address - Street 2:1-256 MEDICAL EDUCATION BUILDING
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-5224
Practice Address - Country:US
Practice Address - Phone:808-295-3309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports