Provider Demographics
NPI:1700359486
Name:WEIMER, HOLLY SUZANNE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:SUZANNE
Last Name:WEIMER
Suffix:
Gender:F
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 1:6002 PINE PARK ST
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WI
Mailing Address - Zip Code:54476-3570
Mailing Address - Country:US
Mailing Address - Phone:330-703-3125
Mailing Address - Fax:
Practice Address - Street 1:2400 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-6738
Practice Address - Country:US
Practice Address - Phone:330-703-3125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-06
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0015751225100000X
ALPTH8986225100000X
PAPT026945225100000X
FL34428225100000X
WI14632-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist