Provider Demographics
NPI:1831641109
Name:WEIDMAN, HEATHER CHRISTINA (ATC, MAT, CEAS)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:CHRISTINA
Last Name:WEIDMAN
Suffix:
Gender:F
Credentials:ATC, MAT, CEAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10205L MULBERRY LN
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60455-6000
Mailing Address - Country:US
Mailing Address - Phone:708-307-5307
Mailing Address - Fax:
Practice Address - Street 1:4714 GETTYSBURG RD
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-4325
Practice Address - Country:US
Practice Address - Phone:888-735-6332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960030222255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer