Provider Demographics
NPI:1124252853
Name:WEEDON, JANE ELIZABETH (PT)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:ELIZABETH
Last Name:WEEDON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 PROSPECT PARK SW
Mailing Address - Street 2:APT. #A6
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-5969
Mailing Address - Country:US
Mailing Address - Phone:917-586-9825
Mailing Address - Fax:
Practice Address - Street 1:70 PROSPECT PARK SW
Practice Address - Street 2:APT. #A6
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-5969
Practice Address - Country:US
Practice Address - Phone:917-586-9825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-09
Last Update Date:2009-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024256225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist