Provider Demographics
NPI:1558667857
Name:WEEKS, DASHA OLEKSANDRIVNA (LMT)
Entity Type:Individual
Prefix:
First Name:DASHA
Middle Name:OLEKSANDRIVNA
Last Name:WEEKS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:DARYNA
Other - Middle Name:OLEKSANDRIVNA
Other - Last Name:WEEKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:104 MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-3839
Mailing Address - Country:US
Mailing Address - Phone:315-399-7526
Mailing Address - Fax:
Practice Address - Street 1:104 MAPLE LN
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-3839
Practice Address - Country:US
Practice Address - Phone:315-399-7526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024541225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist