Provider Demographics
NPI:1144376369
Name:WEAVER, DANIEL CLINE (PT, RN)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:CLINE
Last Name:WEAVER
Suffix:
Gender:M
Credentials:PT, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 515
Mailing Address - Street 2:
Mailing Address - City:CRAIG
Mailing Address - State:AK
Mailing Address - Zip Code:99921-0515
Mailing Address - Country:US
Mailing Address - Phone:907-826-2661
Mailing Address - Fax:
Practice Address - Street 1:13004 KLAWOCK-HOLLIS HWY
Practice Address - Street 2:
Practice Address - City:KLAWOCK
Practice Address - State:AK
Practice Address - Zip Code:99925
Practice Address - Country:US
Practice Address - Phone:907-755-4800
Practice Address - Fax:907-755-4908
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK11232163WG0000X
AK896225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice