Provider Demographics
NPI:1649747254
Name:WEAVER, TIMOTHY JOSEPH JR
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JOSEPH
Last Name:WEAVER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2954 CARLISLE RD
Mailing Address - Street 2:
Mailing Address - City:GARDNERS
Mailing Address - State:PA
Mailing Address - Zip Code:17324-9509
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2954 CARLISLE RD
Practice Address - Street 2:
Practice Address - City:GARDNERS
Practice Address - State:PA
Practice Address - Zip Code:17324-9509
Practice Address - Country:US
Practice Address - Phone:717-706-9296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant