Provider Demographics
NPI:1760640544
Name:WEISSERT, WILLIAM C (PT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:WEISSERT
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 1:109 LANTER CT
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-6124
Mailing Address - Country:US
Mailing Address - Phone:618-343-1122
Mailing Address - Fax:618-343-1444
Practice Address - Street 1:109 LANTER CT
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-6124
Practice Address - Country:US
Practice Address - Phone:618-343-1122
Practice Address - Fax:618-343-1444
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.014877225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist