Provider Demographics
NPI:1801848510
Name:WEINANDY, MICHELLE ANN (MPT)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ANN
Last Name:WEINANDY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27432 ALISO CREEK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-5337
Mailing Address - Country:US
Mailing Address - Phone:949-448-0872
Mailing Address - Fax:949-448-0984
Practice Address - Street 1:27432 ALISO CREEK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-5337
Practice Address - Country:US
Practice Address - Phone:949-448-0872
Practice Address - Fax:949-448-0984
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT19704225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14562Medicare ID - Type UnspecifiedGROUP NUMBER
CAWPT19704AMedicare PIN