Provider Demographics
NPI:1982396495
Name:WEITZEL, COLTON JAMES
Entity type:Individual
Prefix:
First Name:COLTON
Middle Name:JAMES
Last Name:WEITZEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 4TH ST S UNIT 127
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4293
Mailing Address - Country:US
Mailing Address - Phone:941-893-9423
Mailing Address - Fax:
Practice Address - Street 1:2106 BISPHAM RD STE C
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-5522
Practice Address - Country:US
Practice Address - Phone:941-952-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician