Provider Demographics
NPI:1992195846
Name:FENG, WEINA (MSPT)
Entity Type:Individual
Prefix:
First Name:WEINA
Middle Name:
Last Name:FENG
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CLARK DR APT 118
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3724
Mailing Address - Country:US
Mailing Address - Phone:650-504-3598
Mailing Address - Fax:
Practice Address - Street 1:2 CLARK DR APT 118
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3724
Practice Address - Country:US
Practice Address - Phone:650-504-3598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8699171100000X
CA26699225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist