MEDICARE: ELIZABETH M WEIMER LMT, CLT

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	225700000X	Massage Therapist	MA60986315	WA

General Provider Information

NPI Number	:	1821805607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH M WEIMER LMT, CLT

Provider Business Mailing Address
First Line	:	1416 E SUMACH ST
Second Line	:
City	:	WALLA WALLA
State	:	WA
Zip	:	99362-8984
Country	:	US
Telephone Number	:	609-703-6232
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 E MAIN ST STE 304
Second Line	:
City	:	WALLA WALLA
State	:	WA
Zip	:	99362-1900
Country	:	US
Telephone Number	:	609-703-6232
Fax Number	:

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

Provider Enumeration Date	:	12/14/2024
Last Update Date	:	12/14/2024

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