Provider Demographics
NPI:1477976306
Name:WEINHAGEN, MALIA
Entity Type:Individual
Prefix:MRS
First Name:MALIA
Middle Name:
Last Name:WEINHAGEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1686 ROSEWOOD AVE S
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-3633
Mailing Address - Country:US
Mailing Address - Phone:952-353-7092
Mailing Address - Fax:
Practice Address - Street 1:1245 GUN CLUB RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3379
Practice Address - Country:US
Practice Address - Phone:651-484-9009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist