Provider Demographics
NPI:1457601734
Name:WEINER, REBECCA (DPT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:WEINER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:GOLDSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:5777 W MAPLE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2271
Mailing Address - Country:US
Mailing Address - Phone:248-938-0078
Mailing Address - Fax:248-282-5361
Practice Address - Street 1:5777 W MAPLE RD STE 200
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2271
Practice Address - Country:US
Practice Address - Phone:248-938-0078
Practice Address - Fax:248-282-5361
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035414225100000X
MI5501017804225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist