Provider Demographics
NPI:1912014333
Name:WEIDENMAN, KRISTEL M (PT, MA)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEL
Middle Name:M
Last Name:WEIDENMAN
Suffix:
Gender:F
Credentials:PT, MA
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Mailing Address - Street 1:713 WALT WHITMAN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2202
Mailing Address - Country:US
Mailing Address - Phone:631-425-5900
Mailing Address - Fax:631-424-9850
Practice Address - Street 1:713 WALT WHITMAN RD
Practice Address - Street 2:SUITE B
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-2202
Practice Address - Country:US
Practice Address - Phone:631-425-5900
Practice Address - Fax:631-424-9850
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY015674-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ27B91Medicare ID - Type Unspecified