MEDICARE: SHEILA WIEBENS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	AT9197	CA

General Provider Information

NPI Number	:	1154712024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEILA WIEBENS

Provider Business Mailing Address
First Line	:	GOLDENVILLE SUBDIVISION BANAWA,
Second Line	:
City	:	CEBU CITY
State	:	CEBU
Zip	:	6000
Country	:	PH
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6545 GREEN VALLEY CIR UNIT 107
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-8092
Country	:	US
Telephone Number	:	310-384-8218
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2015
Last Update Date	:	02/12/2015

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