Provider Demographics
NPI:1841264504
Name:WEISBECK, KENT M (ATC, LICENSED)
Entity type:Individual
Prefix:MR
First Name:KENT
Middle Name:M
Last Name:WEISBECK
Suffix:
Gender:M
Credentials:ATC, LICENSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 MAYFAIR DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-3507
Mailing Address - Country:US
Mailing Address - Phone:585-338-9471
Mailing Address - Fax:585-338-9471
Practice Address - Street 1:1 WAR MEMORIAL SQ
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14614-2109
Practice Address - Country:US
Practice Address - Phone:585-454-5335
Practice Address - Fax:585-454-3954
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000405-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer