Provider Demographics
NPI:1467185025
Name:WEAVER, AARON (DPT)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:WEAVER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 QUAIL RUN DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-1830
Mailing Address - Country:US
Mailing Address - Phone:574-309-6707
Mailing Address - Fax:
Practice Address - Street 1:3221 BEACON PKWY
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-7196
Practice Address - Country:US
Practice Address - Phone:574-647-2930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05014221A208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation