1225219546 NPI number — DR. SARA ELIZABETH WEISNER PT, DPT, LAT, ATC

Table of content: DR. SARA ELIZABETH WEISNER PT, DPT, LAT, ATC (NPI 1225219546)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225219546 NPI number — DR. SARA ELIZABETH WEISNER PT, DPT, LAT, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEISNER
Provider First Name:
SARA
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT, LAT, ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHARNESKIE
Provider Other First Name:
SARA
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT,DPT,LAT,ATC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1225219546
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 BLYTHE BLVD
Provider Second Line Business Mailing Address:
OUTPATIENT THERAPY DEPARTMENT
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28203-5814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-355-4347
Provider Business Mailing Address Fax Number:
704-355-4333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 BLYTHE BLVD
Provider Second Line Business Practice Location Address:
OUTPATIENT THERAPY DEPARTMENT
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28203-5814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-355-4347
Provider Business Practice Location Address Fax Number:
704-355-4333
Provider Enumeration Date:
11/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X , with the licence number:  11354 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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