Provider Demographics
NPI:1821805607
Name:WEIMER, ELIZABETH M (LMT, CLT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:WEIMER
Suffix:
Gender:F
Credentials:LMT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 E SUMACH ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-8984
Mailing Address - Country:US
Mailing Address - Phone:609-703-6232
Mailing Address - Fax:
Practice Address - Street 1:103 E MAIN ST STE 304
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-1900
Practice Address - Country:US
Practice Address - Phone:609-703-6232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-14
Last Update Date:2024-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60986315225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist