Provider Demographics
NPI:1972650083
Name:WEEDA, BRIAN JOSEPH (MS, PT, TPI)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:JOSEPH
Last Name:WEEDA
Suffix:
Gender:M
Credentials:MS, PT, TPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 OHIO ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4637
Mailing Address - Country:US
Mailing Address - Phone:360-714-0870
Mailing Address - Fax:360-714-0872
Practice Address - Street 1:420 OHIO ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4637
Practice Address - Country:US
Practice Address - Phone:360-714-0870
Practice Address - Fax:360-714-0872
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006136225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA102764OtherLABOR & INDUSTRY
5017495OtherAETNA
650020464OtherRAILROAD MEDICARE
WA15938OtherREGENCE
WA8327652Medicaid
A003OtherTRICARE
A003OtherTRICARE
S40584Medicare UPIN