Basic Information
| Provider Information | |||||||||
| NPI: | 1891991733 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEIDEMOYER | ||||||||
| FirstName: | BRIDGET | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 187 MILLBURN AVE | ||||||||
| Address2: | |||||||||
| City: | MILLBURN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070411847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9734677976 | ||||||||
| FaxNumber: | 9734677971 | ||||||||
| Practice Location | |||||||||
| Address1: | 64 RIVER RD | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | EAST HANOVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079363536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9734281050 | ||||||||
| FaxNumber: | 9734281051 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA00784800 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.