Individual
BRIAN CARLTON WEIDERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
3645 E. OVERLAND RD., MERIDIAN, ID 83642
(208) 888-7765
(208) 888-7955
Mailing address
16083 SW UPPER BOONES FERRY RD, SUITE 300, PORTLAND, OR 97224-7736
(800) 219-8835
(503) 639-9699
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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