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General NPI Number Information
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NPI Number | 1356925119
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Entity Type | Individual
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Provider Name | MATTHEW ALAN WEINBERG LMT
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Gender | Male
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Dates
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Enumeration Date | 05/07/2021
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Last Update Date | 05/07/2021
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Provider Practice Location Address
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Address Line | 27115 185TH AVE SE STE 107
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City | COVINGTON
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State | WA
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Zip | 98042-8449
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Country | US
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Telephone | 707-710-6811
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Fax |
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Provider Business Mailing Address
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Address Line | 30412 227TH PL SE
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City | BLACK DIAMOND
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State | WA
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Zip | 98010-1288
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Country | US
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Telephone | 707-710-6811
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 61108938
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License Number State | WA
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