Provider Demographics
NPI:1578501599
Name:WEISS, HERBERT EDWARD (PT)
Entity Type:Individual
Prefix:MR
First Name:HERBERT
Middle Name:EDWARD
Last Name:WEISS
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 1:461 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-1930
Mailing Address - Country:US
Mailing Address - Phone:410-526-5300
Mailing Address - Fax:410-526-7245
Practice Address - Street 1:461 MAIN STREET
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-1930
Practice Address - Country:US
Practice Address - Phone:410-526-5300
Practice Address - Fax:410-526-7245
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15198225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
J921Medicare UPIN