Provider Demographics
NPI:1245296128
Name:WEDDERMAN, WAYNE ALLAN JR (ATC)
Entity type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:ALLAN
Last Name:WEDDERMAN
Suffix:JR
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 BENGAL BLVD.
Mailing Address - Street 2:
Mailing Address - City:BARNEGAT
Mailing Address - State:NJ
Mailing Address - Zip Code:08005
Mailing Address - Country:US
Mailing Address - Phone:609-660-7510
Mailing Address - Fax:
Practice Address - Street 1:180 BENGAL BLVD
Practice Address - Street 2:
Practice Address - City:BARNEGAT
Practice Address - State:NJ
Practice Address - Zip Code:08005-2159
Practice Address - Country:US
Practice Address - Phone:609-660-7510
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000784002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer