Provider Demographics
NPI:1841519279
Name:WIEDMANN, CLAIRE (PT)
Entity type:Individual
Prefix:MRS
First Name:CLAIRE
Middle Name:
Last Name:WIEDMANN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:CLAIRE
Other - Middle Name:
Other - Last Name:MUNRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:341 10TH AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROYERSFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19468-3807
Mailing Address - Country:US
Mailing Address - Phone:610-792-8100
Mailing Address - Fax:610-792-1535
Practice Address - Street 1:341 10TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ROYERSFORD
Practice Address - State:PA
Practice Address - Zip Code:19468-3807
Practice Address - Country:US
Practice Address - Phone:610-792-8100
Practice Address - Fax:610-792-1535
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT011395L2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic