Provider Demographics
NPI:1164709762
Name:WEAVER, KRISTEN FRANCES (PTA)
Entity Type:Individual
Prefix:MISS
First Name:KRISTEN
Middle Name:FRANCES
Last Name:WEAVER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 3 BOX 377
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WV
Mailing Address - Zip Code:26354-9566
Mailing Address - Country:US
Mailing Address - Phone:304-612-4825
Mailing Address - Fax:
Practice Address - Street 1:130 KAUFMAN DR
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-2179
Practice Address - Country:US
Practice Address - Phone:304-363-4891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1433225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant