Provider Demographics
NPI:1154722726
Name:WECKWERTH, TAWNIA (LMT)
Entity type:Individual
Prefix:
First Name:TAWNIA
Middle Name:
Last Name:WECKWERTH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1160 AAWA DR
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-3904
Mailing Address - Country:US
Mailing Address - Phone:808-298-6525
Mailing Address - Fax:
Practice Address - Street 1:91-1160 AAWA DR
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-3904
Practice Address - Country:US
Practice Address - Phone:808-298-6525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-15
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60486689172M00000X
HIMAT14419172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist