Provider Demographics
NPI:1578885125
Name:WEIDNER, KRISTI D (ATC)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:D
Last Name:WEIDNER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:D
Other - Last Name:WEIDNER-RAWLINGS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:507 E CHERRY ST
Mailing Address - Street 2:P0 BOX 27
Mailing Address - City:ROBINSON
Mailing Address - State:IL
Mailing Address - Zip Code:62454-3305
Mailing Address - Country:US
Mailing Address - Phone:217-259-2006
Mailing Address - Fax:
Practice Address - Street 1:507 E CHERRY ST
Practice Address - Street 2:P0 BOX 27
Practice Address - City:ROBINSON
Practice Address - State:IL
Practice Address - Zip Code:62454-3305
Practice Address - Country:US
Practice Address - Phone:217-259-2006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960018122255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer