Provider Demographics
NPI:1487063251
Name:WERBER, TATIANA (PT)
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:
Last Name:WERBER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TATIANA
Other - Middle Name:
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1975 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-1309
Mailing Address - Country:US
Mailing Address - Phone:860-513-1431
Mailing Address - Fax:860-529-0126
Practice Address - Street 1:3912 EXCELSIOR BLVD
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416
Practice Address - Country:US
Practice Address - Phone:528-354-5129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11231225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist