Provider Demographics
NPI:1295913259
Name:WIEDMANN, ANITA DIANE (RPT)
Entity type:Individual
Prefix:MISS
First Name:ANITA
Middle Name:DIANE
Last Name:WIEDMANN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:MISS
Other - First Name:DIANE
Other - Middle Name:ANITA
Other - Last Name:WIEDMANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPT
Mailing Address - Street 1:1609 RAWLINGS DRIVE
Mailing Address - Street 2:
Mailing Address - City:PICKERING
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L1V5B6
Mailing Address - Country:CA
Mailing Address - Phone:905-420-4203
Mailing Address - Fax:
Practice Address - Street 1:580 HARWOOD AVE. S
Practice Address - Street 2:
Practice Address - City:AJAX
Practice Address - State:ONTARIO
Practice Address - Zip Code:L1S2J4
Practice Address - Country:CA
Practice Address - Phone:905-683-2320
Practice Address - Fax:905-428-5204
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5609225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist