Provider Demographics
NPI:1659659951
Name:WEIMER, TRISTA LEEANN (PT, OCS)
Entity Type:Individual
Prefix:DR
First Name:TRISTA
Middle Name:LEEANN
Last Name:WEIMER
Suffix:
Gender:F
Credentials:PT, OCS
Other - Prefix:
Other - First Name:TRISTA
Other - Middle Name:L
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3041 W HORIZON RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3948
Mailing Address - Country:US
Mailing Address - Phone:702-565-6565
Mailing Address - Fax:702-565-8898
Practice Address - Street 1:8402 CENTENNIAL PKWY STE 240
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4793
Practice Address - Country:US
Practice Address - Phone:702-294-7499
Practice Address - Fax:702-294-7494
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6602225100000X
IN05010775A225100000X
NV5115225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist