Provider Demographics
NPI:1982713400
Name:WEHKING, JEREMY LUKE (PT)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:LUKE
Last Name:WEHKING
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8381 SW 164TH ST
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-3640
Mailing Address - Country:US
Mailing Address - Phone:305-433-1172
Mailing Address - Fax:305-433-1172
Practice Address - Street 1:5901 SW 74TH ST STE 201
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5150
Practice Address - Country:US
Practice Address - Phone:305-433-1172
Practice Address - Fax:305-726-0003
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT25605225100000X
MD21922225100000X
CO11056225100000X
FLPT327252251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT32725OtherPHYSICAL THERAPY BOARD
CO11056OtherPHYSICAL THERAPY BOARD
FLPT25605OtherPHYSICAL THERAPY BOARD