Individual
SHAUN G WEEDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
218 E BROAD ST FL 2, WESTFIELD, NJ 07090-2120
(908) 868-5700
Mailing address
218 E BROAD ST FL 2, WESTFIELD, NJ 07090-2120
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
40QB00262700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
40QB00262700
PTA LICENSE
NJ
Enumeration date
11/18/2010
Last updated
11/18/2010
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