Provider Demographics
NPI:1477935617
Name:ALLEN WEAVIL, LAURA (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:ALLEN WEAVIL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 601791
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1791
Mailing Address - Country:US
Mailing Address - Phone:336-996-7001
Mailing Address - Fax:336-996-0832
Practice Address - Street 1:1730 KERNERSVILLE MEDICAL PKWY STE 201
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-7198
Practice Address - Country:US
Practice Address - Phone:336-996-7001
Practice Address - Fax:336-996-0832
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12503225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist