Provider Demographics
NPI:1215281563
Name:WEIDLICH, MEGAN CATHERINE (DPT)
Entity type:Individual
Prefix:MISS
First Name:MEGAN
Middle Name:CATHERINE
Last Name:WEIDLICH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8630 164TH AVE NE STE 203
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3606
Mailing Address - Country:US
Mailing Address - Phone:425-658-4980
Mailing Address - Fax:
Practice Address - Street 1:1700 WESTLAKE AVE NE SUITE 400
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-3606
Practice Address - Country:US
Practice Address - Phone:425-658-4980
Practice Address - Fax:425-658-4977
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60291071225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist