Provider Demographics
NPI:1447804687
Name:WEIR, GAVIN III (PT, DPT, CSCS)
Entity Type:Individual
Prefix:DR
First Name:GAVIN
Middle Name:
Last Name:WEIR
Suffix:III
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17200 OAK PARK AVE UNIT 306
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-3639
Mailing Address - Country:US
Mailing Address - Phone:312-857-8180
Mailing Address - Fax:
Practice Address - Street 1:706 CENTER RD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1600
Practice Address - Country:US
Practice Address - Phone:312-857-8180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID6356225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist