Provider Demographics
NPI:1952321218
Name:WEIDES, ANDREW L (PT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:L
Last Name:WEIDES
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:2810 W 35TH ST
Mailing Address - Street 2:STE 2
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-2909
Mailing Address - Country:US
Mailing Address - Phone:308-237-7388
Mailing Address - Fax:308-237-7394
Practice Address - Street 1:516 W 14TH AVE
Practice Address - Street 2:STE 200
Practice Address - City:HOLDREGE
Practice Address - State:NE
Practice Address - Zip Code:68949
Practice Address - Country:US
Practice Address - Phone:308-995-2865
Practice Address - Fax:308-995-4127
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2014-10-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE2078225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist