Provider Demographics
NPI:1881404952
Name:WIEGAND, ANDREW A (PT, DPT, CSCS)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:A
Last Name:WIEGAND
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18000 COVE STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456
Mailing Address - Country:US
Mailing Address - Phone:616-847-1280
Mailing Address - Fax:616-847-1290
Practice Address - Street 1:5481 EAST APPLE AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-3065
Practice Address - Country:US
Practice Address - Phone:231-722-5661
Practice Address - Fax:231-722-5660
Is Sole Proprietor?:No
Enumeration Date:2025-01-10
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5501303671225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist