NPI UPIN PREFIX FIRST_NAME MIDDLE_NAME LAST_NAME SUFFIX CREDENTIAL PRO_PREFIX PRO_FIRSTNAME PRO_MIDDLENAME PRO_LASTNAME PRO_SUFFIX PRO_CREDENTIAL GENDER SPECIALTY LICENSE_NUM LICENSE_ST ENUM_DATE DEACT_DATE REACT_DATE MAILINGADDR_LN1 MAILINGADDR_LN2 MAILINGADDR_CITY MAILINGADDR_ST MAILINGADDR_POSTCODE MAILINGADDR_COUNTRY MAILINGADDR_TEL MAILINGADDR_FAX PRACADDR_LN1 PRACADDR_LN2 PRACADDR_CITY PRACADDR_ST PRACADDR_POSTCODE PRACADDR_COUNTRY PRACADDR_TEL PRACADDR_FAX 1003000506 Keisha L. Butler MA, LPC F Professional Counselor 19723 TX 08-28-2007 100 N Central Expy Suite 400-8 Dallas TX 75201-4312 US 214-298-7647 469-227-4251 100 N Central Expy Suite 400-8 Dallas TX 75201-4312 US 214-298-7647 469-227-4251 1003000522 Frederick Weigand MD M Adult Medicine ME13473 FL 08-28-2007 1565 Saxon Blvd Ste 202 Deltona FL 32725-5836 US 386-789-5550 386-532-7152 1565 Saxon Blvd Ste 202 Deltona FL 32725-5836 US 386-789-5550 386-532-7152 1003000530 Dr. Amanda Marie Owens DO F Internal Medicine OT011604 PA 08-28-2007 801 Ostrum St Bethlehem PA 18015-1000 US 610-954-4000 801 Ostrum St Bethlehem PA 18015-1000 US 610-954-4000 1003000548 Philip Aranda PTA M Physical Therapy Assistant 2023620 TX 08-28-2007 1779 Nacogdoches Rd Apt 122 San Antonio TX 78209-2709 US 210-744-7482 855 E Basse Rd San Antonio TX 78209-1890 US 210-824-6280 1003000555 Mrs. Manisha Ajit Patel DPT F Physical Therapist 070.01425 IL 08-28-2007 1401 E State St Rockford IL 61104-2315 US 815-489-4470 815-490-5858 1401 E State St Rockford IL 61104-2315 US 815-489-4470 815-490-5858 1003000589 Holly A Davidson F Student in an Organized Health Care Education/Training Program 08-28-2007 760 Harrison St San Francisco CA 94107-1235 US 415-836-1700 415-836-1737 760 Harrison St San Francisco CA 94107-1235 US 415-836-1700 415-836-1737 1003000597 Dr. Dae Kim MD M Urology IL 08-28-2007 2723 N Monticello Ave First Floor Chicago IL 60647-1131 US 2723 N Monticello Ave First Floor Chicago IL 60647-1131 US 773-331-4797 1003000605 Miss Diane Elizabeth Freeman OTR F Specialist 5201003946 MI 08-28-2007 11035 E Richfield Rd Davison MI 48423-8517 US 810-654-2422 8220 S Saginaw St Ste 800 Grand Blanc MI 48439-1890 US 810-603-3841 1003000621 Dr. Dennis Dullano DC M Chiropractor 0104556571 VA 08-28-2007 2411 E Franklin St Unit 108 Richmond VA 23223-7879 US 3660 Boulevard Rd Suite G Colonial Heights VA 23834 US 804-526-7125 1003000639 Dr. Peyman Benharash MD M Surgery A85379 CA 08-27-2007 1000 W Carson St Torrance CA 90502-2004 US 310-222-2700 310-533-1841 1000 W Carson St Torrance CA 90502-2004 US 310-222-2700 310-533-1841 1003000647 Ms. Nicole Marie Lepore MSOT, OTR F Pediatrics Occupational Therapist 46TR00426800 NJ 08-28-2007 150 New Providence Rd Mountainside NJ 07092-2590 US 150 New Providence Rd Mountainside NJ 07092-2590 US 908-233-3720 1003000654 Dr. Caroline Marie Rhodes DDS F General Practice, Dentist 55219 CA 08-28-2007 606 Fisher St Keesler AFB MS 39534-2513 US 228-376-0511 606 Fisher St Keesler AFB MS 39534-2513 US 228-376-0511 1003000662 Kathleen Ann Baker F Professional Counselor IL 08-28-2007 1001 Rohlwing Rd Elk Grove Village IL 60007-3217 US 847-524-8800 1001 Rohlwing Rd Elk Grove Village IL 60007-3217 US 847-524-8800 1003006016 Robin Thomas F Case Manager/Care Coordinator 07-26-2007 2640 Breslauer Way Redding CA 96001-4246 US 2640 Breslauer Way Redding CA 96001-4246 US 530-225-5200 1003006024 Dr. Mark Darrin Unruh DDS, MS M Orthodontics and Dentofacial Orthopedics 5338 OK 07-26-2007 425 S Madison Blvd Bartlesville OK 74006-2826 US 918-333-3628 425 S Madison Blvd Bartlesville OK 74006-2826 US 918-333-3628 1003006073 Ms. Catherine Ann Weibel MPT F Sports Physical Therapist 70014519 IL 07-26-2007 3430 N Lake Shore Dr Apt 4J Chicago IL 60657-2872 US 772-532-5812 3430 N Lake Shore Dr Apt 4J Chicago IL 60657-2872 US 772-532-5812 1003006099 Elizabeth Ostoja RDMS F Sonography Radiologic Technologist 117674 07-26-2007 4815 W Belle Plaine Ave Apt 209 Chicago IL 60641-1841 US 773-736-1762 4815 W Belle Plaine Ave Apt 209 Chicago IL 60641-1841 US 773-736-1762 1003006107 Saad M Al-Saab MD M Cardiovascular Disease 231401 MA 07-26-2007 51 Queensberry St Apt #2 Boston MA 02215-4854 US 617-732-5500 Brigham and Women's Hospital 75 Francis Street Boston MA 02215 US 617-732-5500 1003006115 Mr. Benjamin Durham PA-C M Physician Assistant 005084 GA 07-26-2007 PO Box 7000 Columbus GA 31908-7000 US 706-322-2462 706-320-3227 2300 Manchester Expy # A Suite 101-A Columbus GA 31904-6802 US 706-322-2462 706-320-3227 1003006131 Mr. Thomas S. Bender LPCC M Counselor 3377 NM 07-25-2007 PO Box 338 Grand Ronde OR 97347-0338 US 503-879-2236 503-879-5089 9605 Grand Ronde Rd Grand Ronde OR 97347-9712 US 503-879-2236 503-879-5089