Provider Demographics
NPI:1558668061
Name:WEAVER, CATHERINE (LMT)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:KAITE
Other - Middle Name:
Other - Last Name:WEAVER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:PO BOX 2661
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-2661
Mailing Address - Country:US
Mailing Address - Phone:503-724-0550
Mailing Address - Fax:503-723-5112
Practice Address - Street 1:2008 WILLAMETTE FALLS DR
Practice Address - Street 2:STE. 200A
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-4658
Practice Address - Country:US
Practice Address - Phone:503-607-0018
Practice Address - Fax:503-723-5112
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18010225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist