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General NPI Number Information
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NPI Number | 1407446412
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Entity Type | Individual
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Provider Name | DENISON F WIEDMAN LMT
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Gender | Male
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Dates
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Enumeration Date | 01/23/2021
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 136 N MAIN AVE
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City | WHITE SALMON
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State | WA
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Zip | 98672-1149
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Country | US
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Telephone | 786-271-2568
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2290 PMB 204
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City | WHITE SALEM
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State | WA
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Zip | 98672
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Country | US
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Telephone | 786-271-2568
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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 | 25542
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 61034962
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License Number State | WA
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