Individual
MR. STEPHEN THEODORE WIESKAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
2109 CEDARWOOD DR STE 100, MUSCATINE, IA 52761-2670
(563) 288-6787
(563) 288-6719
Mailing address
850 43RD AVE STE 100, MOLINE, IL 61265-8401
(309) 743-2070
(309) 743-2073
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
02503
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0263731
—
IA
01
—
349984700
US DEPT OF LABOR WORK COM
IA
01
—
49799
WELLMARK
IA
Enumeration date
07/19/2006
Last updated
03/30/2018
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