Provider Demographics
NPI:1154094068
Name:WEAVER PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:WEAVER PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BROCK
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:724-532-3422
Mailing Address - Street 1:3960 ROUTE 30 STE 104
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-5518
Mailing Address - Country:US
Mailing Address - Phone:724-532-3422
Mailing Address - Fax:724-532-3424
Practice Address - Street 1:3960 ROUTE 30 STE 104
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-5518
Practice Address - Country:US
Practice Address - Phone:724-532-3422
Practice Address - Fax:724-532-3424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-27
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty