Healthcare Provider Details

I. General information

NPI: 1467686097
Provider Name (Legal Business Name): DAVID G WEEKS LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2009
Last Update Date: 03/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 BACA ST SUITE D
SANTA FE NM
87505-0972
US

IV. Provider business mailing address

1515 CAMINO SIERRA VIS UNIT B
SANTA FE NM
87505-1120
US

V. Phone/Fax

Practice location:
  • Phone: 917-214-0226
  • Fax:
Mailing address:
  • Phone: 917-214-0226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0088571
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: