Provider Demographics
NPI:1225286495
Name:WEAVER, ROBIN ANNE (MPT)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:ANNE
Last Name:WEAVER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3662 BOSTONS FARM DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-3167
Mailing Address - Country:US
Mailing Address - Phone:314-770-1863
Mailing Address - Fax:
Practice Address - Street 1:3662 BOSTONS FARM DR
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-3167
Practice Address - Country:US
Practice Address - Phone:314-770-1863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01744225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist