1881404952 NPI number — ANDREW A WIEGAND PT, DPT, CSCS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881404952 NPI number — ANDREW A WIEGAND PT, DPT, CSCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WIEGAND
Provider First Name:
ANDREW
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT, CSCS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881404952
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18000 COVE STREET
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
SPRING LAKE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49456
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-847-1280
Provider Business Mailing Address Fax Number:
616-847-1290

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5481 EAST APPLE AVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
MUSKEGON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49442-3065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-722-5661
Provider Business Practice Location Address Fax Number:
231-722-5660
Provider Enumeration Date:
01/10/2025

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: 225100000X , with the licence number:  5501303671 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com