Provider Demographics
NPI:1043808512
Name:WEAVER, JAMIE LEE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:LEE
Last Name:WEAVER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:LEE
Other - Last Name:SAMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1350 S GUTENSOHN RD STE 10
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-5210
Mailing Address - Country:US
Mailing Address - Phone:479-751-7122
Mailing Address - Fax:479-751-7292
Practice Address - Street 1:9 CUNNINGHAM COR
Practice Address - Street 2:
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72714-3520
Practice Address - Country:US
Practice Address - Phone:479-855-6814
Practice Address - Fax:479-855-6828
Is Sole Proprietor?:No
Enumeration Date:2021-01-09
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist