MEDICARE: MRS. POLINA WEINSTEIN DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT028057	PA

General Provider Information

NPI Number	:	1497387302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. POLINA WEINSTEIN DPT

Provider Business Mailing Address
First Line	:	1329 LOMBARD ST APT 302
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-1014
Country	:	US
Telephone Number	:	267-221-2059
Fax Number	:

Provider Business Practice Location Address
First Line	:	9125 ROOSEVELT BLVD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-2204
Country	:	US
Telephone Number	:	215-331-9363
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2020
Last Update Date	:	02/08/2020

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