Provider Demographics
NPI:1457963191
Name:WEEDEN-BOOTZ, TRESSA DEE (CMT, LMT)
Entity Type:Individual
Prefix:
First Name:TRESSA
Middle Name:DEE
Last Name:WEEDEN-BOOTZ
Suffix:
Gender:F
Credentials:CMT, LMT
Other - Prefix:
Other - First Name:TRESSA
Other - Middle Name:
Other - Last Name:LEMAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:112 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-2635
Mailing Address - Country:US
Mailing Address - Phone:952-220-5938
Mailing Address - Fax:
Practice Address - Street 1:112 W 2ND ST
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-2635
Practice Address - Country:US
Practice Address - Phone:952-220-5938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-22
Last Update Date:2024-03-08
Deactivation Date:2021-04-12
Deactivation Code:
Reactivation Date:2023-12-27
Provider Licenses
StateLicense IDTaxonomies
MN00000000204C00000X, 2081N0008X
MN225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
No2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular Medicine