Provider Demographics
NPI:1649054065
Name:WEIDENAAR, AARON THOMAS (PT, DPT)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:THOMAS
Last Name:WEIDENAAR
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 1:2929 OAK LAWN AVE APT 544
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-5695
Mailing Address - Country:US
Mailing Address - Phone:406-580-1409
Mailing Address - Fax:
Practice Address - Street 1:3535 TRAVIS ST STE 160
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-1428
Practice Address - Country:US
Practice Address - Phone:214-346-9105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1382982225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist