Provider Demographics
NPI:1568536639
Name:WEINMAN, RUSSELL J (PT)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:J
Last Name:WEINMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3866 CARNEGIE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-2718
Mailing Address - Country:US
Mailing Address - Phone:216-621-0022
Mailing Address - Fax:216-621-5479
Practice Address - Street 1:3866 CARNEGIE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-2718
Practice Address - Country:US
Practice Address - Phone:216-621-0022
Practice Address - Fax:216-621-5479
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT001848225100000X
OHAT000175225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0773462Medicaid
OH2101504Medicaid
OH34-13971587A12OtherANTHEM
OH34-13971587A12OtherANTHEM
OH2101504Medicaid