Provider Demographics
NPI:1538312509
Name:WEAVER, TALITHA M
Entity Type:Individual
Prefix:
First Name:TALITHA
Middle Name:M
Last Name:WEAVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TALITHA
Other - Middle Name:M
Other - Last Name:WEAVER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:8709 COMMUNITY SQUARE LN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-5157
Mailing Address - Country:US
Mailing Address - Phone:240-882-6393
Mailing Address - Fax:
Practice Address - Street 1:8709 COMMUNITY SQUARE LN
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-5157
Practice Address - Country:US
Practice Address - Phone:240-882-6393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22366225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist