Provider Demographics
NPI:1639211717
Name:WEINSTEIN, EDMUND M (LMT)
Entity Type:Individual
Prefix:MR
First Name:EDMUND
Middle Name:M
Last Name:WEINSTEIN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 GLENGARY ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-3606
Mailing Address - Country:US
Mailing Address - Phone:941-925-3557
Mailing Address - Fax:941-925-3557
Practice Address - Street 1:1906 GLENGARY ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-3606
Practice Address - Country:US
Practice Address - Phone:941-925-3557
Practice Address - Fax:941-925-3557
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA12255225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
C5500Medicare UPIN