Provider Demographics
NPI:1679572408
Name:WEGMANN, EMILY REPANICH (PT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:REPANICH
Last Name:WEGMANN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3214 CHARLES B ROOT WYND
Mailing Address - Street 2:STE 101
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-5440
Mailing Address - Country:US
Mailing Address - Phone:919-571-9912
Mailing Address - Fax:855-291-6382
Practice Address - Street 1:3214 CHARLES B ROOT WYND
Practice Address - Street 2:STE 101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-5440
Practice Address - Country:US
Practice Address - Phone:919-571-9912
Practice Address - Fax:855-291-6382
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016934225100000X
NC116772251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2068297OtherUNITED HEALTHCARE
P00259443OtherMEDICARE RAILROAD
2353697000OtherINDEPENDENCE BLUE CROSS
NC2504284OtherMEDICARE NUMBER
7038213OtherAETNA PPO
47241OtherGEISINGER HEALTH PLAN
7439972OtherCIGNA HEALTHCARE
2170560OtherMAMSI
2353697000OtherAMERIHEALTH
50045030OtherCAPITAL BLUE CROSS
821692OtherFIRST PRIORITY HEALTH
1679776OtherHIGHMARK BLUE SHIELD
2353697000OtherKEYSTONE HEALTH EAST
50045030OtherKEYSTONE HEALTH CENTRAL
329154OtherHEALTHAMERICA/HEALTHASSUR
P3615017OtherOXFORD HEALTH PLANS
7038213OtherAETNA PPO