Provider Demographics
NPI:1992424733
Name:WEISHAAR, MICHA JO (LMT)
Entity type:Individual
Prefix:
First Name:MICHA
Middle Name:JO
Last Name:WEISHAAR
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 1:1625 W 4TH AVE LOWR LEVEL200
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-5620
Mailing Address - Country:US
Mailing Address - Phone:509-624-5855
Mailing Address - Fax:
Practice Address - Street 1:1625 W 4TH AVE LOWR 200
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-5620
Practice Address - Country:US
Practice Address - Phone:509-624-5855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61183922225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist