Provider Demographics
NPI:1669420006
Name:WEIR, JEFFREY DOUGLAS (ATC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DOUGLAS
Last Name:WEIR
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:WOLVERINE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390-2348
Mailing Address - Country:US
Mailing Address - Phone:248-668-9321
Mailing Address - Fax:
Practice Address - Street 1:16200 HUBBARD DR
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-4155
Practice Address - Country:US
Practice Address - Phone:313-593-1703
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer