Provider Demographics
NPI:1053577643
Name:WIEAND, RICHARD JOSEPH (PT)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:JOSEPH
Last Name:WIEAND
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 1:560 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-2157
Mailing Address - Country:US
Mailing Address - Phone:716-674-1509
Mailing Address - Fax:716-674-1787
Practice Address - Street 1:560 CENTER RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-2157
Practice Address - Country:US
Practice Address - Phone:716-674-1509
Practice Address - Fax:716-674-1787
Is Sole Proprietor?:No
Enumeration Date:2008-08-03
Last Update Date:2008-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030432-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000530642001OtherBLUE CROSS AND BLUE SHIELD OF WNY
NYRB9287OtherMEDICARE
NY9315295OtherINDEPENDENT HEALTH
NY1053577643OtherUNIVERA HEALTH CARE
NY161585629OtherMANAGE PHYSICAL NETWORK(EMPIRE PLAN)