Provider Demographics
NPI:1972697977
Name:WIEGREFE, BRETT A (PT)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:A
Last Name:WIEGREFE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8322 BELLONA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2012
Mailing Address - Country:US
Mailing Address - Phone:410-337-8847
Mailing Address - Fax:410-769-8591
Practice Address - Street 1:9110 PHILADELPHIA RD STE 314
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-4327
Practice Address - Country:US
Practice Address - Phone:410-616-1401
Practice Address - Fax:410-686-6315
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD21016225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q22364Medicare UPIN