Provider Demographics
NPI:1245959170
Name:WEINSTEIN, THEADORA I
Entity type:Individual
Prefix:
First Name:THEADORA
Middle Name:I
Last Name:WEINSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 156
Mailing Address - Street 2:
Mailing Address - City:GIRDWOOD
Mailing Address - State:AK
Mailing Address - Zip Code:99587-0156
Mailing Address - Country:US
Mailing Address - Phone:907-854-0293
Mailing Address - Fax:
Practice Address - Street 1:337 ALTA DR.
Practice Address - Street 2:UNIT A
Practice Address - City:GIRDWOOD
Practice Address - State:AK
Practice Address - Zip Code:99587
Practice Address - Country:US
Practice Address - Phone:907-854-0293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist