Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 7501003179 | MI |
NPI | 1013497288 |
---|---|
Provider Name | Thomas E Weiberg |
First Address | Waterford, MI 48328-2927 |
Second Address | Waterford, MI 48328-3677 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2018 |
Last Update Date | 17/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7501003179 | ABMP (01) | MI |