Individual
BRIAN CARLTON WEIDERMAN
Active
Individual
BRIAN CARLTON WEIDERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT2663
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0330321
WA L&I
ID
05
—
1831419332
—
ID
01
—
P00846336
RR MEDICARE
ID
Enumeration date
06/07/2010
Last updated
10/08/2014
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