Provider Demographics
NPI:1578542551
Name:C WEAVER PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:C WEAVER PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/HEAD PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, ATC, MTC
Authorized Official - Phone:517-333-6692
Mailing Address - Street 1:1720 ABBEY RD
Mailing Address - Street 2:SUITE A & B
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-6363
Mailing Address - Country:US
Mailing Address - Phone:517-333-6692
Mailing Address - Fax:517-333-6705
Practice Address - Street 1:1720 ABBEY RD
Practice Address - Street 2:SUITE A & B
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6363
Practice Address - Country:US
Practice Address - Phone:517-333-6692
Practice Address - Fax:517-333-6705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003354261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI236663Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER