Provider Demographics
NPI:1326762170
Name:WEAVER, ABIGAIL PAIGE
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:PAIGE
Last Name:WEAVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 QUARTERS RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-5631
Mailing Address - Country:US
Mailing Address - Phone:636-474-9592
Mailing Address - Fax:
Practice Address - Street 1:322 QUARTERS RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-5631
Practice Address - Country:US
Practice Address - Phone:636-474-9592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant