Provider Demographics
NPI:1821474180
Name:WEISSERT, MARIA DOLORES
Entity Type:Individual
Prefix:
First Name:MARIA DOLORES
Middle Name:
Last Name:WEISSERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4239 LA FRANCE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34286-6621
Mailing Address - Country:US
Mailing Address - Phone:941-276-8093
Mailing Address - Fax:
Practice Address - Street 1:4239 LA FRANCE AVE
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34286-6621
Practice Address - Country:US
Practice Address - Phone:941-276-8093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-09
Last Update Date:2015-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT119982251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics