Provider Demographics
NPI:1710960448
Name:WEINBERGER, STEPHEN RALPH (PT OCS)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:RALPH
Last Name:WEINBERGER
Suffix:
Gender:M
Credentials:PT OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:101 W CATALDO AVE
Practice Address - Street 2:STE 300
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-3200
Practice Address - Country:US
Practice Address - Phone:509-326-7311
Practice Address - Fax:509-326-7314
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2492225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1710960448Medicaid
111068OtherWA STATE L I
WA7080112Medicaid
WAG8960101Medicare PIN
WA7080112Medicaid