Provider Demographics
NPI:1770851941
Name:WEINSTEIN, LIANA MIRIAM (LMT)
Entity Type:Individual
Prefix:
First Name:LIANA
Middle Name:MIRIAM
Last Name:WEINSTEIN
Suffix:
Gender:F
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?:Yes
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 62614172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA 62614OtherLICENSE