Provider Demographics
NPI:1376623058
Name:WEAVER, AMY STANLEY (PT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:STANLEY
Last Name:WEAVER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3045 SCOTTCREST WAY
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-7461
Mailing Address - Country:US
Mailing Address - Phone:704-843-7243
Mailing Address - Fax:704-973-0775
Practice Address - Street 1:3045 SCOTTCREST WAY
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-7461
Practice Address - Country:US
Practice Address - Phone:704-843-7243
Practice Address - Fax:704-973-0775
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6270225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist