Provider Demographics
NPI:1891991733
Name:WEIDEMOYER, BRIDGET (PT)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:WEIDEMOYER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 MILLBURN AVE
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1847
Mailing Address - Country:US
Mailing Address - Phone:973-467-7976
Mailing Address - Fax:973-467-7971
Practice Address - Street 1:64 RIVER RD
Practice Address - Street 2:SUITE 1
Practice Address - City:EAST HANOVER
Practice Address - State:NJ
Practice Address - Zip Code:07936-3536
Practice Address - Country:US
Practice Address - Phone:973-428-1050
Practice Address - Fax:973-428-1051
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00784800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ080264SUSMedicare ID - Type Unspecified