Individual
MRS. AMANDA LYNNE WEIDNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
23715 LITTLE MACK AVE STE 200, SAINT CLAIR SHORES, MI 48080-1181
(586) 447-4064
(586) 447-4069
Mailing address
53581 DEERFIELD LN, NEW BALTIMORE, MI 48047-6395
(586) 292-6005
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501012049
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1932396017
—
MI
Enumeration date
02/27/2018
Last updated
02/27/2018
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