Provider Demographics
NPI:1649514274
Name:WIEGER, ANDREA SABINE (PT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:SABINE
Last Name:WIEGER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 W ROSCOE ST
Mailing Address - Street 2:APT BB
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3542
Mailing Address - Country:US
Mailing Address - Phone:847-256-2890
Mailing Address - Fax:
Practice Address - Street 1:651 W WASHINGTON BLVD STE 305
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-2137
Practice Address - Country:US
Practice Address - Phone:773-216-4567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070010468225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist