Provider Demographics
NPI:1568211001
Name:WEITZEL, EMILY (ATC/LAT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:WEITZEL
Suffix:
Gender:F
Credentials:ATC/LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2466 HICKORY DR
Mailing Address - Street 2:
Mailing Address - City:NEW RICHMOND
Mailing Address - State:OH
Mailing Address - Zip Code:45157-8705
Mailing Address - Country:US
Mailing Address - Phone:513-340-5684
Mailing Address - Fax:
Practice Address - Street 1:13 CAROTHERS RD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:KY
Practice Address - Zip Code:41071-2415
Practice Address - Country:US
Practice Address - Phone:859-292-0001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT19952255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer