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General NPI Number Information
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NPI Number | 1154712024
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Entity Type | Individual
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Provider Name | SHEILA WIEBENS
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Gender | Female
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Dates
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Enumeration Date | 02/12/2015
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Last Update Date | 02/12/2015
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Provider Practice Location Address
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Address Line | 6545 GREEN VALLEY CIR UNIT 107
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City | CULVER CITY
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State | CA
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Zip | 90230-8092
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Country | US
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Telephone | 310-384-8218
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Fax |
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Provider Business Mailing Address
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Address Line | GOLDENVILLE SUBDIVISION BANAWA,
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City | CEBU CITY
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State | CEBU
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Zip | 6000
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Country | PH
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | AT9197
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License Number State | CA
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