Individual
MRS. COLLEEN B. WEITEKAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
006609
CT
2251P0200X
Pediatric Physical Therapist
006609
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
021239-1
—
NY
Enumeration date
06/07/2006
Last updated
12/18/2020
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