Provider Demographics
NPI:1356173918
Name:WEIGEL, MITCHELL (PT, DPT)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:WEIGEL
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 E SHOREWOOD BLVD UNIT 311
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-2539
Mailing Address - Country:US
Mailing Address - Phone:414-323-0320
Mailing Address - Fax:
Practice Address - Street 1:4749 S 76TH ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4301
Practice Address - Country:US
Practice Address - Phone:414-281-1380
Practice Address - Fax:414-281-1381
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16848-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist