Provider Demographics
NPI:1992711634
Name:WEISMAN, BRIAN IRA (PT)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:IRA
Last Name:WEISMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BUSINESS CENTER DR
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-1230
Mailing Address - Country:US
Mailing Address - Phone:410-833-3025
Mailing Address - Fax:
Practice Address - Street 1:801 TOLL HOUSE AVE STE H3
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-6117
Practice Address - Country:US
Practice Address - Phone:240-575-9380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18749225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD7446385OtherAETNA
MDKCY1OtherCAREFIRST MD
MD532P059HMedicare PIN