Provider Demographics
NPI:1255364493
Name:WEICHERS, SHANTELLE A (ATC, CSCS)
Entity type:Individual
Prefix:MS
First Name:SHANTELLE
Middle Name:A
Last Name:WEICHERS
Suffix:
Gender:F
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5426 CAREY DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-7039
Mailing Address - Country:US
Mailing Address - Phone:319-239-2738
Mailing Address - Fax:319-268-0321
Practice Address - Street 1:1731 W RIDGEWAY AVE
Practice Address - Street 2:STE 600
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-4595
Practice Address - Country:US
Practice Address - Phone:319-833-5900
Practice Address - Fax:319-833-5901
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer