Basic Information
| Provider Information | |||||||||
| NPI: | 1366527723 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WIEGAND | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | D.P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 520 PHILADELPHIA ST | ||||||||
| Address2: | |||||||||
| City: | INDIANA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 157013902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7244637478 | ||||||||
| FaxNumber: | 7244630931 | ||||||||
| Practice Location | |||||||||
| Address1: | 2605 EGYPT RD | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | TROOPER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194032317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106661702 | ||||||||
| FaxNumber: | 6106661726 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT018209 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | WI1886723 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 2749209000 | 01 | PA | INDEPENDENCE BLUE CROSS | OTHER | 50060610 | 01 | PA | CAPITAL BLUE CROSS/KHPC | OTHER | 44418 | 01 | PA | HEATH AMER/HEALTH ASSUR | OTHER | 7735811 | 01 | PA | AETNA | OTHER |