Provider Demographics
NPI:1568583060
Name:WEIL, JENNIFER LYNNE (PT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNNE
Last Name:WEIL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNNE
Other - Last Name:OCZYKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:11229 E RENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-4158
Mailing Address - Country:US
Mailing Address - Phone:602-690-9578
Mailing Address - Fax:480-358-9487
Practice Address - Street 1:11229 E RENFIELD AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-4158
Practice Address - Country:US
Practice Address - Phone:602-690-9578
Practice Address - Fax:480-358-9487
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ57142251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics