Provider Demographics
NPI:1740912997
Name:WEIDERSTROM, ABBY SUE (PHYSICAL THERAPY)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:SUE
Last Name:WEIDERSTROM
Suffix:
Gender:F
Credentials:PHYSICAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:9612 270TH ST NW STE 103
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-1911
Mailing Address - Country:US
Mailing Address - Phone:360-629-8043
Mailing Address - Fax:
Practice Address - Street 1:9612 270TH ST NW STE 103
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-1911
Practice Address - Country:US
Practice Address - Phone:360-629-8043
Practice Address - Fax:360-629-8053
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT61256387225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist