Healthcare Provider Details

I. General information

NPI: 1003036633
Provider Name (Legal Business Name): PAUL WEINER CERTIFIED PEDORTHIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7036 W PALMETTO PARK RD STE 59
BOCA RATON FL
33433-3404
US

IV. Provider business mailing address

7036 W PALMETTO PARK RD STE 59
BOCA RATON FL
33433-3404
US

V. Phone/Fax

Practice location:
  • Phone: 561-338-3838
  • Fax:
Mailing address:
  • Phone: 561-338-3838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: